A vacuum extraction is attempted for a prolonged second stage. After three pull attempts with no descent, the cup detaches. The most appropriate next step is:
- A Immediately apply obstetric forceps
- B Attempt a fourth pull with the vacuum
- C Proceed to caesarean section ✓
- D Ask the patient to push harder without instrumental assistance
Correct answer: C. Proceed to caesarean section
Explanation
Sequential use of vacuum followed by forceps ('failed vacuum, try forceps') significantly increases the risk of neonatal intracranial haemorrhage and is generally contraindicated. Pop-off of the cup is considered a failed vacuum attempt. After three pulls without descent or cup detachment, the procedure should be abandoned and caesarean section performed. Attempting a fourth pull increases neonatal injury without improving delivery success.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.