Modes of deliveryFree in the app
Assisted vaginal birth
Forceps or vacuum — prerequisites and when to stop.
Source: RCOG GTG 26Prerequisites
- Head ≤1/5 palpable abdominally; at or below spines
- Cervix fully dilated, membranes ruptured
- Position known (ultrasound if unsure); caput/moulding ≤ moderate
- Adequate pelvis; consent; good analgesia
- Bladder empty / catheter balloon deflated
- Competent operator; theatre backup for mid-cavity
Classification
| Outlet | Scalp visible without parting labia; on perineum; rotation ≤45°. |
|---|---|
| Low | Skull at +2 cm or below, not on perineum. |
| Mid | ≤1/5 palpable; station 0 or +1. |
Instrument
| Vacuum | Less perineal trauma; more failure, cephalhaematoma. Not <32 weeks; caution 32–36. Not for face. |
|---|---|
| Forceps | More OASI; for face, after-coming breech head, or no maternal effort. |
| Rotational | Kielland’s, manual rotation, or rotational vacuum (Kiwi). |
Stop if no descent with each pull, birth not imminent after 3 pulls, or 2 cup detachments. Sequential instruments increase neonatal injury.
After: co-amoxiclav 1.2 g IV within 6 h; record first void; VTE reassessment.
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.