The iCup is an instrument used to obtain flexion, limited traction and induced rotation, and it can be used to assist a woman to give birth via the natural birth canal.
The pre-conditions for using this obstetrical device must comply with the following criteria, which should only be viewed as guidelines in view of the differences between one delivery and another, and between the techniques used by different obstetricians:
A clear indication for extraction
Facilities available to carry out a C section without delay if vaginal delivery is not possible: it is essential to carry out instrumental fetal extractions in a room close to the cesarean theater or even in the same room
If an extraction is indicated, the obstetrician must take a few minutes to explain the situation to the parents. The consent and active participation of the mother giving birth by a vacuum-assisted fetal extraction is essential in order to obtain effective pushing during traction
Completely aseptic conditions
An empty bladder. A draining catheter can be inserted before inserting the instrument if necessary
Peridural anesthesia is desirable. General anesthesia is not necessary and a hindrance: the patient needs to participate by pushing because her uterine contractions plus pushing efforts provide 60% of the total force required for the delivery
The waters must have broken
Cephalic presentation
The cervix must be fully dilated
The orientation, degree of deflexion and asynclitism of the fetal head must be fully established in order to position the instrument properly. The cup should be placed as near to the occiput as possible. The longer the lever (the distance between the atloido-occipital joint and the occiput) the easier it will be to achieve flexion of the head, and the less traction force will have to be applied to achieve it. An error of diagnosis would result in using the cup as a deflexion instrument, leading to dystocia. Vaginal palpation to locate the fontanelles, the sutures or even the ears can correctly determine the presentation. Abdominal palpation, to locate the buttocks and back of the fetus, indicates the side of the occiput. If any doubt remains (caput succedaneum, asynclitism), do an ultrasound scan in the labor room. Locating the back of the fetus makes it possible to decide whether it is a right or left presentation. If at least one eyeball is easy to see, this will confirm the posterior form, if the eyes cannot be seen, then it is an anterior form. Also make use of the usual anatomical landmarks
(cerebellum, thalamus, ...)
The level of the presentation must be clearly established. The engagement of the fetal presentation in the middle of the pelvis is essential
