Rapid versus stepwise negative pressure application for vacuum extraction assisted vaginal delivery.

backgroundVacuum extraction is a common technique of assisted vaginal delivery. Traditionally, it has been recommended that the pressure is increased slowly in a stepwise procedure; some have advocated rapid increases in pressure.

objectivesTo assess the efficacy and safety of rapid versus stepwise negative pressure application for assisted vaginal delivery by vacuum extraction. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2008). SELECTION CRITERIA: Randomized controlled trials and quasi-randomized controlled trials of rapid compared with stepwise increase in negative pressure application of vacuum extraction. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. MAIN

resultsOne trial of 94 women was included. Duration of vacuum procedure was reduced in rapid application group (mean difference -6.10 minutes, 95% confidence interval -8.83 to -3.37). There were no significant differences in detachment rate, degree of perineal tears, Apgar score less than seven at one and five minutes, umbilical venous pH less than 7.2, scalp laceration greater than a quarter, cephalhematoma and number of tractions. AUTHORS'

conclusionsThe rapid negative pressure application for vacuum assisted vaginal birth reduces the duration of the procedure whilst there is no evidence of differences in maternal and neonatal outcome. Due to a small number of participants in the single included trial, the evidence is limited and either policy may be employed until further controlled trials provide conclusive evidence of benefit from one or other method.