Vacuum extraction is CONTRAINDICATED in: March 2013
**Core Concept**
Vacuum extraction is a delivery technique used to assist in the delivery of the baby. It involves the use of a vacuum extractor to help guide the baby's head out of the birth canal. However, there are certain situations where vacuum extraction is not recommended.
**Why the Correct Answer is Right**
Vacuum extraction is contraindicated in situations where the fetal head is too large for the birth canal, or where there are concerns about the baby's well-being. In cases of cephalopelvic disproportion, where the baby's head is too large to pass through the mother's pelvis, vacuum extraction is not recommended. This is because the risk of complications, such as head trauma or facial injuries, is increased in these situations.
**Why Each Wrong Option is Incorrect**
**Option A:** **Placenta previa** - Vacuum extraction is not contraindicated in placenta previa, and in fact, may be used in conjunction with other delivery methods to help facilitate a safe delivery.
**Option B:** **Fetal distress** - While fetal distress is a concern in any delivery, it is not a contraindication for vacuum extraction. In fact, vacuum extraction may be used to help expedite delivery in situations where the baby is in distress.
**Option C:** **Cephalopelvic disproportion** - This is the correct answer. Vacuum extraction is contraindicated in cases of cephalopelvic disproportion, where the baby's head is too large to pass through the mother's pelvis.
**Option D:** **Multiple gestations** - Vacuum extraction is not contraindicated in multiple gestations. In fact, vacuum extraction may be used to help deliver multiple babies in a single delivery.
**Clinical Pearl / High-Yield Fact**
When considering vacuum extraction, it is essential to assess the baby's size and the mother's pelvis to determine if the delivery is feasible. A cephalometric x-ray or ultrasound may be used to assess the baby's head size and the mother's pelvis.
**Correct Answer:** C. Cephalopelvic disproportion.