During a vacuum-assisted delivery at full dilatation, the cup detaches twice despite correct technique. The fetal head is at station +2. What should be done?
- A Attempt a third vacuum application
- B Switch to forceps delivery
- C Proceed to immediate cesarean section ✓
- D Allow passive descent for 30 more minutes
Correct answer: C. Proceed to immediate cesarean section
Explanation
The 'three-pull rule' or 'cup-off twice' rule applies to vacuum: if the cup detaches twice (pop-offs), vacuum delivery should be abandoned. Sequential use of vacuum followed by forceps (failed vacuum then forceps) is associated with significantly increased neonatal morbidity including intracranial hemorrhage and is not recommended. The correct next step after failed vacuum is cesarean section, not forceps. Passive descent further is inappropriate after failed operative delivery.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.