During an attempted vacuum-assisted delivery for fetal distress at +2 station, the cup detaches three times ('pop-offs'). The correct action is:

• A Proceed with a fourth attempt after repositioning the cup centrally
• B Abandon vacuum and apply forceps to complete delivery
• C Increase traction force on next attempt with additional fundal pressure
• D Abandon operative vaginal delivery and proceed to cesarean section ✓

Explanation

According to ACOG and RCOG guidelines, vacuum extraction should be abandoned and cesarean delivery performed if: (1) there are three cup detachments ('pop-offs'), (2) there is no progressive descent with each pull, or (3) after a maximum of 3 traction attempts or 10–20 minutes total. Sequential use of vacuum followed by forceps (or vice versa) — 'sequential instrument use' — is associated with significantly increased neonatal intracranial hemorrhage risk and is generally contraindicated. After vacuum failure, cesarean is the recommended next step.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.