title: Obstetric management in vacuum-extraction deliveries.
abstract: OBJECTIVE
  The aim of this observational study was to describe the obstetric management in vacuum extraction (VE) deliveries and to compare these findings to instructions in clinical guidelines on VE.
  
  
  METHODS
  In 2013, detailed data on management of 600 VE cases were consecutively collected from six different delivery units in Sweden. Each unit also contributed their own clinical VE guideline.
  
  
  RESULTS
  In total, 93% of the VEs ended with a vaginal delivery while 7% failed and were converted to an emergency cesarean section. In 2.3% extraction time exceeded 20 minutes, and in 6% more than six pulls were used to deliver the fetus. Cup detachment occurred in 14.6%, and fundal pressure was used in 11% of the deliveries. In 2.3%, fetal station was assessed as above the level of the maternal ischial spines. The clinical guidelines on VE varied in scope and content between units, and were often incomplete according to best practice.
  
  
  CONCLUSIONS
  The vast majority of the VEs were conducted in accordance with safety recommendations. However, in a few extractions, safety rules were disregarded and more than six pulls or an extraction time of more than 20 minutes were used to complete the delivery.
authors.affiliation: Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. Electronic address: mia.ahlberg@ki.se.
authors.forename: Mia
authors.initials: M
authors.lastname: Ahlberg
authors.affiliation: Department of Clinical Science and Education, South General Hospital, Karolinska Institutet, Stockholm, Sweden; Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Sissel
authors.initials: S
authors.lastname: Saltvedt
authors.affiliation: Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Ekéus
mesh_terms: D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods; D004630:Emergencies; D004868:Equipment Failure; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D061214:Patient Safety; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011312:Pressure; D013548:Sweden; D014618:Vacuum; D014620:Vacuum Extraction, Obstetrical / Q000592:standards*; D014621:Vagina
keywords: Clinical guidelines; Clinical management; Duration; Fetal station; Pulls; Vacuum extraction