A woman in active second stage of labour for 90 minutes (nullipara with epidural) has the fetal head at +2 station, occiput anterior. CTG shows recurrent late decelerations. The obstetrician decides on operative vaginal delivery. Which of the following correctly characterizes the conditions under which vacuum extraction is preferred over forceps in current clinical practice?

• A Vacuum preferred in rotation from OP to OA; forceps preferred when rotation is not required and outlet delivery is needed under maternal pushing ✓
• B Vacuum is preferred at ≥34 weeks gestation when the head is above +2 station; forceps preferred for face presentation
• C Vacuum is preferred in preterm (<34 weeks), face presentation, or when anticoagulants were given
• D Forceps are associated with less maternal pelvic floor injury; vacuum is associated with more maternal perineal trauma

Explanation

Current evidence and RCOG guidelines: Vacuum (Ventouse) extraction is better tolerated for rotational deliveries (OP to OA) and is associated with less maternal perineal trauma but more neonatal cephalohematoma and subgaleal hemorrhage. Forceps provide more reliable rotation and traction without fetal scalp injury, preferred when rapid delivery is needed with maternal pushing, or when vacuum has failed. Vacuum is CONTRAINDICATED in prematurity (<34 weeks), face/brow presentations, known fetal coagulopathy, and after fetal scalp blood sampling. Forceps are preferred in these situations, not vacuum.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.