KEY POINTS

• Operative vaginal deliveries have been declining overall, and the ratio of vacuum to forceps deliveries has increased.

• Avoid forceps rotations exceeding 45° and do not attempt to forcibly rotate the head with a vacuum device because of the potential for injury and litigation.

• The best candidates for operative vaginal delivery have a prolonged second stage of labor or non-reassuring fetal status, the fetal head at the outlet or low in the pelvis, and a functioning epidural.

• Avoid sequential use of vacuum and forceps.

Panelists

Neal M. Lonky, MD, MPH, moderator of this discussion, is director of medical education and colposcopic services, department of obstetrics and gynecology, Kaiser Permanente, Orange County, Calif. He serves on the board of directors, Southern California Permanente Group, and is clinical professor of obstetrics and gynecology at the University of California, Irvine. He is an OBG Management contributing editor.

James A. Bofill, MD, is associate professor, division of maternal-fetal medicine, University of Mississippi Medical Center, Jackson, Miss.

Thomas Garite, MD, is E.J. Quilligan Professor and chair, obstetrics and gynecology, University of California, Irvine.

Robert Hayashi, MD, is J. Robert Willson Professor of obstetrics and director, division of maternal-fetal medicine, University of Michigan, Ann Arbor, Mich.

Victor L. Vines, MD, is in private practice, Medical City Dallas Hospital, Dallas, Tex. He serves on the physician advisory board for the Perinatal Safety Initiative of the Hospital Corporation of America and is clinical associate professor of obstetrics and gynecology at the University of Texas Southwestern Medical Center, Dallas.