During the second stage of labour, a term fetus in occiput posterior (OP) position fails to rotate spontaneously. The vertex is at +2 station and the patient has been pushing for 90 minutes with regional anaesthesia. Which rotational instrument specifically designed for this presentation offers the lowest risk of maternal perineal trauma?
- A Kielland's forceps with anterior rotation
- B Wrigley's forceps applied in the direct OP position
- C Ventouse with Kiwi OmniCup or metal cup for rotation ✓
- D Piper's forceps applied to the aftercoming head
Explanation
For persistent occiput posterior position, ventouse/vacuum extraction is preferred over rotational forceps for maternal safety (lower risk of major perineal tears and maternal injury). The Kiwi OmniCup or metal cup can be applied to the flexion point and uses traction to promote autorotation (fetal head corrects as it descends). Kielland's forceps can achieve mechanical rotation but carries higher risk of vaginal lacerations, uterine rupture, and fetal injury due to rotational manoeuvres and requires high operator skill. Wrigley's forceps are outlet forceps, not suitable for +2 station rotational delivery. Piper's forceps are specifically for the aftercoming head in breech deliveries.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.