Operative Vaginal Delivery with Forceps

Introduction to Operative Vaginal Delivery

The American College of Obstetricians and Gynecologists recommends forceps delivery as the preferred operative vaginal method in certain scenarios due to lower failure rates compared to vacuum extraction 1
For patients at 35-36 weeks with fetal head in the vaginal canal and Category 2 CTG, forceps delivery is the preferred operative approach, as vacuum extraction is contraindicated at low station due to high risk of intracranial and subgaleal hemorrhage 1, 2

Forceps delivery is the preferred operative vaginal method in this scenario due to lower failure rates compared to vacuum extraction 1
Vacuum extraction should be avoided when the fetal head is at low station due to increased risk of intracranial and subgaleal hemorrhage 1, 2, 3

Vacuum-assisted delivery should not be performed at low station due to increased risk of significant fetal injury, including intracranial and subgaleal hemorrhage 2, 3
The use of a single forceps blade or ventouse as a lever to disimpact the fetal head is considered dangerous and should be avoided 3

The American College of Obstetricians and Gynecologists recommends placing the patient in lateral decubitus position to attenuate hemodynamic impact of uterine contractions during operative delivery 1, 2
Continuous electronic fetal heart rate monitoring should be maintained throughout the operative delivery 1, 3

If cesarean becomes necessary with impacted fetal head, reverse breech extraction may be associated with better neonatal outcomes including improved Apgar scores and reduced NICU admissions 6, 4
Manual vaginal disimpaction (vaginal push method) can be used to move the fetal head up into the abdomen before making a uterine incision 7, 8

Suspected cephalopelvic disproportion is an absolute contraindication to operative vaginal delivery and requires cesarean section 1, 2
Thoroughly assess for signs of CPD including marked molding, deflexion, or asynclitism of the fetal head without descent 5

Administer slow IV oxytocin (<2 U/min) after placental delivery to prevent hemorrhage while avoiding hypotension 1
Continue hemodynamic monitoring for at least 24 hours postpartum due to fluid shifts 1

Never attempt vacuum extraction when the fetal head is at low station—this is a dangerous practice with high risk of severe fetal injury 1, 2, 3
Do not use a single forceps blade as a lever to disimpact the head—this is considered dangerous and unsupported by evidence 4, 3