Ans. a. Vacuum requires more clinical skills than forceps (Ref: Dutta 7/e p579, 581)Forceps requires more clinical skills than forceps vacuum.Advantages of Ventouse:It is comfortable and has lower rates of maternal trauma and genital tract lacerationsReduced maternal pelvic floor injuries and is advocated as the instrument of the first choicePerineal injuries (3rd and 4th degree tears) are lessDue to above mentioned reasons, Vacuum is preferred more than forceps in HIV patient to decrease the transmission. Comparison of Forceps Vs VentouseAdvantages of VentouseAdvantages of Forceps* It can be used in the unrotated or malrotated head (OP, OT position), it helps in auto rotation* It is not a space-occupying device* Traction force is less (10 kg)Q* It is comfortable and has lower rates of maternal trauma and genital tract lacerations* Analgesia need is less* Reduced maternal pelvic floor injuries and is advocated as the instrument of the first choice* Perineal injuries (3rd and 4th degree tears) are less* Post-partum maternal discomfort (pain) is less* Easier to learn* The simplicity of use in delivery makes it convenient to the operator (suitable for trained midwives)* In case, where moderate traction is required, forceps will be more effective* Forceps operation can quickly expedite the delivery in case of fetal distress* Safer in premature babies* Can be employed in the anterior face or after coming head of the breech presentation* Lesser neonatal scalp trauma, retinal hemorrhage, jaundice or cephalhematoma* The higher rate of successful vaginal delivery* Cup detachment (pop-off) occurs when the vacuum is not maintained in ventouse* No. of types of forceps are available for an outlet, mid-cavity or rotational delivery Complications of Forceps OperationMaternal-Fetal* Injury: vaginal laceration, sulcus tear, cervical tear, complete perineal tear* Nerve injury: Femoral (L2, 3, 4), lumbosacral trunk with mid-forceps delivery* Post-partum hemorrhage* Anesthetic complications* Puerperal sepsis and maternal morbidity* Remote:* Painful perineal scars, dyspareunia, low back ache, genital prolapse, stress urinary incontinence, and anal sphincter dysfunctionImmediate:* Asphyxia, facial bruising, intracranial hemorrhage, facial palsy, skull fractures, cervical spine injury (rotational forceps)Remote:* Cerebral or spastic palsy Complications of Ventouse OperationMaternalFetal* Injuries are uncommon* Soft tissue such as cervix or vaginal wall may be injured* Superficial scalp abrasion* Sloughing of the scalp* CephalhematomaQ* Subgaleal hemorrhage* Intracranial hemorrhage (rare)* Retinal hemorrhage* Jaundice