A multiparous woman in active labour has been fully dilated for 2.5 hours without delivery. Fetal heart rate shows variable decelerations. The fetal head is at +2 station, occiput anterior, moulding 1+. Which mode of operative vaginal delivery is most appropriate?

• A Vacuum (ventouse) extraction
• B Mid-cavity forceps delivery
• C Emergency cesarean section
• D Outlet forceps delivery ✓

Explanation

An outlet forceps delivery is appropriate when the fetal skull has reached the pelvic floor (station +2 or +3 with scalp visible at introitus without separating the labia), in occiput anterior position with minimal moulding. The conditions are met here: +2 station, OA position, moulding 1+, and fetal distress (variable decelerations) requiring expedited delivery. Forceps is preferred over vacuum when fetal distress requires rapid, controlled delivery and rotation is not needed. Mid-cavity forceps applies when the head is between 0 and +2 station and is a higher-risk procedure requiring specific expertise.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.