During a mid-cavity vacuum-assisted delivery, the cup detaches (pop-off) after three pulls without descent. The fetal head is at +1 station, occiput anterior. Appropriate management at this point is:

• A Reapply the cup and attempt two more pulls
• B Immediately apply Kielland forceps for rotation
• C Abandon instrumental delivery and proceed to cesarean section ✓
• D Perform fundal pressure (Kristeller manoeuvre) while reapplying the cup

Explanation

Three pop-offs or three pulls without descent indicate a failed vacuum extraction; sequential use of forceps after failed vacuum significantly increases neonatal morbidity and is not recommended as routine practice. Guidelines recommend abandoning the attempt and proceeding to cesarean section. Kristeller manoeuvre is not acceptable in modern obstetrics and is associated with serious maternal and fetal injury.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.