During forceps delivery, the cup slip (forceps slipping off the fetal head 3 times) is a recognized indication for abandonment of the procedure. According to RCOG/ACOG guidelines, operative vaginal delivery (OVD) should be abandoned and cesarean performed if which criterion is met?

• A Three pulls without descent or delivery not imminent after reasonable effort ✓
• B Maternal exhaustion after two full tractions with adequate analgesia
• C Fetal scalp pH <7.20 on fetal blood sampling before commencing OVD
• D Caput succedaneum extending beyond the introitus prior to first pull

Explanation

RCOG Green-top Guideline No. 26 (Operative Vaginal Delivery) states that OVD should be abandoned if there is no progressive descent with each pull, or if delivery is not imminent after three contractions with active pushing. The 'three pull rule' is a safety principle to prevent traumatic delivery. Failed OVD requiring emergency cesarean carries significant maternal and neonatal morbidity, so any hesitation or lack of progress should prompt abandonment. Sequential use of forceps after failed vacuum (or vice versa) increases injury risk and should only be undertaken by experienced practitioners in specific circumstances.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.