Trends in obstetric policies in cases of failed vacuum extraction in Japan.

Objective: In April 2008, the guidelines for obstetric practice in Japan have made the following recommendations: (1) do not use vacuum extraction (VE) for more than 20 min, and consider forceps delivery (FD) or an emergency cesarean section (CS) if necessary (20-minute VE trial rule), and (2) do not try VE more than five times, even if VE has been used for less than 20 min (5-time VE trial rule). The aims of the present study were to compare the obstetric policies related to failed VE before and after 2008. Methods: We reviewed the obstetric records of all cases of VE in cases of singleton pregnancy with a neonatal birth weight ≥ 2500 g beyond 37 weeks' gestation at our hospital from April 2002 to March 2014. Results: The success rate of VE decreased significantly (96.8 versus 94.1%, p  = .02), while the rate of CS increased significantly (2.2 versus 5.0%, p  < .01); however, there were no significant differences in these values between the two periods. Conclusions: We could not find the effects of the recommendation limiting the practice of VE.