30Unfavourable features Trial of Labour Epidural anaesthesia RCOG GTG No.20Term Breech trialUnfavourable featuresTrial of LabourEpidural anaesthesiaMauriceau-Smellie-Veit manoeuvreBurns-Marshall manoeuvreLovset’s manoeuvreAfter-coming head
35This is a disposable, vacuum delivery system. It consists of a cup and a handle, connected by plastic tubing.
36The cup contains a yellow, foam pad. This prevents blockage of the tubing during a vacuum delivery.
37The handle contains a vacuum indicator. It is marked in yellow, green and red.
38The handle also contains a traction force indicator. It is marked in kilograms and pounds. It also has a vacuum release button
39Application of the “Kiwi” cup All the usual conditions for operative vaginal delivery are present i.e. full dilatation of the cervix, ruptured membranes, empty bladder, the presenting part is cephalic, etc.Use plenty of obstetric cream on the cup.Place two fingers at the fourchette and insert the cup.Apply the cup to the “flexion point” of the fetal head. Place the groove on the cup along the sagittal suture so that you can check for rotation of the head during the delivery.Use the pump to increase the vacuum to the “yellow mark”Check that there is no vaginal wall trapped by the cup.Wait for a contraction. Increase the vacuum to the “green mark”Apply traction along the axis of the birth canal.After delivery release the vacuum using the vacuum release button. Check the scalp of the baby after delivery.