A 29-year-old in second stage of labour has a prolonged deceleration to 80 bpm lasting 8 minutes. The cervix is fully dilated, station +3, OA position, and outlet is adequate. She cannot push due to epidural. Which intervention is MOST appropriate?

• A Emergency caesarean section
• B Kielland's forceps rotation
• C Ventouse (vacuum) extraction ✓
• D Intrauterine resuscitation with tocolytics and reassessment

Explanation

This is an emergency at station +3 in OA position with a fully dilated cervix — prerequisites for outlet/low operative vaginal delivery are met. Ventouse extraction is the appropriate first-choice instrument for this indication (fetal distress in second stage, vertex at +3 in OA). Emergency caesarean would be slower to achieve delivery than operative vaginal at this station. Kielland's forceps is for rotational deliveries, not required in OA. Tocolysis delays necessary delivery in acute fetal compromise.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.