Comparison vacuum extractor versus forceps

The aim of the study was to search for objective criteria witch might help us to make a choice between obstetrical forceps and vacuum extractor in front of such a clinical situation. In that purpose, we realised a medline research to compare those two obstetrical instruments in term of advantages, disadvantages and specific complications. Vacuum extractor is the most used in the industrialized countries, learning seems to be quickest, time from decision to extraction a little bit longer than with forceps (Level II-2). Vacuum extractor is recommended in case of low presentation with transversal or posterior variety (Level III) or when no analgesia is available (Level III). Forceps are more successful than vacuum (Level II-1), are recommended in case of prematurity and complete anesthesia (Level III). Immediate maternal complications (cervical tear, vaginal and perineal laceration, use of episiotomy) are less frequent with vacuum extractor (Level II-1). Long term effects on the pelvic floor and the bladder continence are comparable with natural delivery for both forceps and vacuum (Level II-1) but anal incontinence is increased, especially with forceps (Level II-1). Benign immediate neonatal morbidity is comparable for both instruments, but there are some specific complications (Level II-1). Thus, cephalhaematomas and potentially dramatic extensive subgaleal haematomas (even rare), retinal haemorrhage are more frequent with the use of vacuum extractor (Level II-1). Facial nerve paralysis, skull fracture (even rare) are more frequent with forceps (Level II-2). Neonatal convulsions frequency is comparable with both instruments (Level II-2), such are middle and long term complications (Level II-3). Finally, failure of forceps extraction needs a caesarean section but there is no clear evidence in the literature for the sequential use of forceps after failure of vacuum (Level III).