During a vacuum-assisted vaginal delivery, the cup detaches three times ('three pop rule'). What is the recommended action at this point?

• A Switch to low forceps delivery as the scalp has been sufficiently prepared by vacuum traction
• B Apply a metal cup instead of soft cup and reattempt with additional traction
• C Abandon the instrumental delivery and proceed to emergency cesarean section ✓
• D Allow a 30-minute rest period and reassess fetal position before reattempting

Explanation

The 'three pop rule' (three cup detachments during vacuum delivery) is an absolute indication to abandon vacuum delivery. Three detachments indicate either inadequate application, excessive caput, asynclitism, or true cephalopelvic disproportion — conditions where continued attempts risk serious fetal or maternal trauma. Sequential instrumental delivery (vacuum followed by forceps) is associated with dramatically increased risk of fetal intracranial hemorrhage and scalp trauma. Emergency cesarean section is the appropriate course of action after three pop-offs.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.