Vacuum cup placement during delivery A suggested obstetric quality assessment measure

Objective: To establish standards for the deviation of vacuum cup placement from the ideal location during operative delivery in an academic center. Methods: Data on 92 vacuum deliveries were prospectively obtained. The actual point on the newborns head was determined and both midline and anterior-posterior line deviations from the ideal point of placement were calculated. Results: The most common indication for vacuum extraction was a nonreassuring fetal heart rate (66.7%). The average deviation on the mid anterior-posterior line was 3.72 ± 1.46 cm; the average midline-lateral deviation was 1.92 ± 1.33 cm. There was no statistically significant difference in the cup placement deviations between deliveries performed by residents and consultants. The vacuum procedure failed in 8.6% of the cases. Conclusions: Accurate placement of the vacuum cup on the fetal head is considered to be clinically important. This assumption requires scientific clinical proof. Our local standard for deviation was established and will serve for audit. If safer neonatal and maternal outcomes are demonstrated, the deviation from the ideal placement location ought to become a universal quality measure for vacuum deliveries