A ventouse cup is applied to the fetal head at the flexion point (3 cm anterior to the posterior fontanelle) and two pulls are performed. The cup detaches with the third pull (pop-off). What is the correct management?

• A Abandon ventouse and reassess for cesarean section ✓
• B Reapply the cup and attempt a fourth pull
• C Switch immediately to Kjelland's forceps
• D Apply fundal pressure (Kristeller) to supplement the next attempt

Explanation

The '3-3-3 rule' for vacuum delivery states that if delivery is not achieved after 3 pulls (or within 3 contractions, or within 3 pop-offs), the procedure should be abandoned and the decision for cesarean section made. Pop-off (detachment) counts as a failed attempt. Sequential use of ventouse followed by forceps is associated with significantly increased neonatal morbidity and should be performed only by an experienced operator in specific circumstances, not as routine after pop-off.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.