A patient in active labour has been pushing for 2 hours (primipara) with no descent. The fetal head is at +2 station, OA position. CTG shows recurrent late decelerations. The MOST appropriate operative delivery is:

• A Kjelland's forceps rotation and delivery
• B Emergency caesarean section
• C Outlet forceps application (Tucker-McLane)
• D Ventouse (vacuum extraction) at +2 station ✓

Explanation

At +2 station (below the level of ischial spines) with OA position, vacuum extraction is the instrument of choice for operative vaginal delivery. It is preferred over forceps for non-rotational deliveries at this station when there is fetal distress. Forceps at this station (low forceps) are acceptable, but current evidence favours vacuum as first choice due to lower maternal perineal morbidity. Caesarean is a last resort when vaginal delivery is feasible.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.