OBJECTIVE: To evaluate the clinical performance of a hand-held vacuum delivery system. METHODS: Between December 1999 and September 2000, a prospective audit was undertaken of all vacuum deliveries performed at Derby City General Hospital. RESULTS: In this period, 3296 deliveries occurred, of which 317 (9.6%) were by vacuum. Of these, data were collected on 300 (94.6%), 78 deliveries with the hand-held vacuum and 222 with standard vacuum. There were no differences in the demographic profiles, indication, gestational age at delivery, or birth weights between the two groups (P > .05 in all instances). In all types of delivery, nonrotational and rotational, the hand-held vacuum performed comparably to its contemporaries with no increase in delivery "failures" being noted. There were no differences in the extent or frequency of maternal injuries between the instruments, and other than transient scalp abrasions, there were no significant fetal injuries. CONCLUSION: The hand-held vacuum delivery system is a functionally effective addition to the practitioners' "armory," providing an alternative to the standard metal and silastic cups.