Vacuum extraction: use in a small rural hospital.

The effectiveness of vacuum extraction with the Silastic Obstetrical Vacuum Cup (SOVC), which has a soft, maleable cup, was assessed by two family physicians in a small rural hospital. Vacuum extraction was attempted in 35 of 231 deliveries over an 18-month period, with an overall success rate of 66%. The main indications for vacuum extraction were fetal distress, followed by a prolonged second stage of labour and malrotation of the occiput. The efficiency of the technique improved with experience. The effects of vacuum extraction on the fetus and mother compared favourably with those reported in the literature. After introduction of the SOVC, the rate of primary cesarean section for cephalopelvic disproportion declined, as did the rate of forceps delivery. Despite careful antenatal screening and referral, and the availability of alternatives, delivery by vacuum extraction with the SOVC was found to be a useful and effective adjunct to obstetric practice.