Indications for vacuum-assisted delivery include one or more of the following:
(1) prolonged second stage of labor
(2) fetal distress
(3) malposition of the vertex
Common complications with no clinical significance:
(1) cephalohematoma
(2) nondepressed skull fracture
(3) scalp edema (including caput succedaneum) and/or bruising
(4) retinal hemorrhage
Rare complications that may be serious:
(1) depressed skull fracture
(2) intracranial hemorrhage
(3) subgaleal hemorrhage (below the galea aponeurotica)
Risk factors for complications:
(1) nulliparity of mother
(2) vacuum attempt at mid-station
(3) 4 or more tractions required for extraction
(4) dislodgment of the cup
These risk factors are sensitive but nonspecific (they have a low predictive value).
