Vacuum-assisted delivery is requested for a fetus at 31 weeks gestation with fetal distress at +2 station. Why should the vacuum be avoided?

• A The maternal soft tissues cannot tolerate cup traction before term
• B The preterm scalp is prone to serious injury including subgaleal hemorrhage and intracranial bleeding ✓
• C Vacuum cups cannot achieve adequate suction below 34 weeks
• D Preterm fetuses are always malpositioned, making cup placement unsafe

Explanation

Gestational age under 34 weeks is a relative contraindication to vacuum extraction because the fragile preterm scalp and skull are at high risk of subgaleal hemorrhage, cephalhematoma, and intraventricular hemorrhage. Suction can technically be achieved at any gestation, so option C is false, and prematurity does not itself imply malposition. Forceps are generally preferred if operative vaginal delivery is needed preterm.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.