A vacuum delivery is attempted but fails after three pulls without descent and two cup detachments. According to RCOG Green-top guideline 26, which statement regarding subsequent management is correct?

• A Sequential use of forceps may be attempted if an experienced operator is available
• B Failed ventouse followed by immediate trial of forceps is acceptable practice with informed consent and experienced operator
• C A second vacuum attempt with a different cup size should be offered before escalating
• D Caesarean section should be performed immediately without any further attempt at instrumental delivery ✓

Explanation

RCOG Green-top guideline 26 (2011, updated) defines a failed ventouse as: three contractions with active pushing without progressive descent, or two cup detachments. After a failed ventouse, sequential use of forceps carries significantly higher maternal and neonatal morbidity. RCOG guideline states that after failed vacuum, caesarean section should be performed. The guideline advises against sequential instrument use (ventouse then forceps) except in exceptional circumstances in theatre with full preparations for caesarean section — and even then this must be with explicit documentation of risk-benefit discussion. A second ventouse attempt with a different cup would not be appropriate after two cup detachments.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.