Abstract
Complications during childbirth result in the need for clinicians to use ‘assisted delivery’ in over 12% of cases (UK). After more than 50 years in clinical practice, vacuum assisted delivery (VAD) devices remain a mainstay in physically assisting child delivery; sometimes preferred over forceps due to their ease of use and reduced maternal morbidity. Despite their popularity and enduring track-record, VAD devices have shown little evidence of innovation or design change since their inception. In addition, evidence on the safety and functionality of VAD devices remains limited but does present opportunities for improvements to reduce adverse clinical outcomes. Consequently in this review we examine the literature and patent landscape surrounding VAD biomechanics, design evolution and performance from an engineering perspective, aiming to collate the limited but valuable information from a disparate field and provide a series of recommendations to inform future research into improved, safer, VAD systems.
Highlights
Since 1990, there has been significant improvements in maternal and foetal outcomes during childbirth.[1]
These must be informed by a more rigorous evidence-base, in particular on the biomechanics of vacuum assisted delivery (VAD) systems and how these relate to clinical outcomes
The ease of use and lower maternal morbidity associated VAD devices can make them an appealing delivery option. To further improve these devices to improve factors ranging from clinical usability through to maternal and foetal morbidity, requires a better understanding of the mechanical interaction between the VAD and the foetal scalp
Summary
Since 1990, there has been significant improvements in maternal and foetal outcomes during childbirth.[1]. Non-assisted cephalic delivery, in which the baby’s head emerges first, accounts for nearly 95% of all births.[2,3] In this situation, the mother’s expulsive efforts, combined with the contractive force of the uterus, provide a coordinated motive force to push the baby from the uterus, along the birth canal. This is described clinically in terms of the baby’s descent through the pelvis, marked by ‘station’, as shown in (Figure 1), until the head initially ‘crowns’ (the foetal scalp at the vertex becomes visible between the labia minora, at the introitus) and delivers on the perineum. Complications can occur which impede normal vaginal delivery, or require the delivery to be expedited with common factors including narrowing of the birth passage, foetal distress, intrapartum infection, maternal exhaustion or abnormal positioning or size of the baby.[7,8]
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Schedule a callMore From: Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine
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