1. Delay in the second stage of labour
2. Non-reassuring fetal heart rate
3. Gestation age less than 34 weeks of pregnancy
4. Vertex presentation
Select the correct answer using the code given below.
Ventouse (Vacuum) Delivery: Indications and Prerequisites
The correct answer is option (1, 2 and 4). Ventouse-assisted vaginal delivery is used to expedite the second stage of labour when specific maternal or fetal indications exist, provided the essential prerequisites for safe application are fulfilled.
Analysing Each Statement
- 1. Delay in the second stage of labour: Correct. A prolonged or non-progressing second stage (maternal exhaustion or inadequate expulsive effort) is one of the classic maternal indications for instrumental (ventouse/forceps) delivery.
- 2. Non-reassuring fetal heart rate: Correct. Fetal distress in the second stage, evidenced by a non-reassuring CTG/fetal heart rate pattern, is a well-recognised fetal indication for expediting delivery by ventouse, provided the prerequisites for instrumental delivery are met.
- 3. Gestation age less than 34 weeks of pregnancy: Incorrect — this is a contraindication, not an indication. Vacuum extraction (ventouse) is contraindicated before 34 weeks of gestation because the preterm fetal skull is soft and incompletely ossified, and the scalp is fragile, placing the baby at significantly increased risk of cephalhematoma, subgaleal haemorrhage, and intraventricular haemorrhage. Most protocols avoid ventouse below 34 weeks (some sources use 36 weeks as a stricter cut-off), preferring forceps or caesarean section if instrumental delivery is unavoidable in a preterm fetus.
- 4. Vertex presentation: Correct. A fundamental prerequisite for ventouse application is that the fetus must be in a cephalic/vertex presentation with the head engaged, so the cup can be applied correctly to the flexion point on the fetal scalp. Ventouse must never be used for face, brow, or breech presentations.
Key Prerequisites for Ventouse Delivery (for reference)
- Full cervical dilatation and ruptured membranes
- Vertex presentation with head engaged (at or below the ischial spines)
- Known fetal position
- Adequate pelvis (no cephalopelvic disproportion) and empty maternal bladder
- Gestation generally ≥34 weeks (vacuum avoided in preterm fetuses due to scalp/skull fragility)
- Informed consent and willingness to abandon procedure if it fails, converting to forceps or caesarean section
Conclusion
Since delay in the second stage (1), non-reassuring fetal heart rate (2), and vertex presentation (4) are all valid indications/prerequisites for ventouse delivery, while gestation less than 34 weeks (3) is actually a contraindication, the correct combination is 1, 2 and 4.
Important Questions from Complicated Labour Management
Which of the following are contra- indications to external cephalic version in antenatal management of breech presentation ?
1. Antepartum haemorrhage
2. Multiple pregnancy
3. Reactive Non Stress Test
4. Severe oligohydramnios
Select the correct answer using the code given below :
- Which of the following are the pre-requisites of outlet forceps delivery?
1. Bladder should be empty
2. Membranes should be intact
3. Cervix should be fully dilated
4. Fetal skull has reached level of pelvic floor
Select the correct answer using the code given below : - Given below are the Obstetric maneuvers and their indications. Which one of the following is correctly matched?
- Which one of the following is NOT a method of management of Deep Transverse Arrest with the living fetus?
- Successful version of breech presentation is likely in case all of the following EXCEPT:
