February 2007 · Vol. 19, No. 02Operative vaginal delivery: 10 components of success
The need for forceps or vacuum should not be determined on the fly, but anticipated and evaluated, with a willing patient
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Fast Track
Fetal weight estimations from a careful abdominal examination can be as accurate as ultrasonographic evaluation
Do not perform operative vaginal delivery without the necessary staff and anesthesia for emergent cesarean section
It is possible to feel the fetal skull bone below the ischial spines and still have an unengaged head
When the fetus is malpositioned, cesarean section may be the wisest choice in an emergency, even if the fetal head is at an appropriate station
Use of the vacuum extractor to bring the fetal head to a lower position in order to apply forceps is completely unacceptable
Once an easy operative vaginal delivery becomes impossible, immediate cesarean section is the best option
Dictate a postoperative note for every operative vaginal delivery, successful or not
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Michael
A.
Belfort,
MD, PhDProfessor, Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, and Director of Perinatal Research, HCA Healthcare, Nashville, Tenn
Operative vaginal delivery is a dying art. National databases in the United States and elsewhere have shown this trend for decades.1 Women no longer can be reliably predicted to prefer operative vaginal delivery over cesarean section, and providers caring for delivering mothers (and their families) should not assume that they do. Nor does the 20th century paradigm of operative vaginal delivery as the accepted “next step” between spontaneous vaginal delivery and cesarean section hold up, given the decreased maternal and neonatal morbidity and mortality associated with modern techniques of cesarean section. Nevertheless, operative vaginal delivery remains a viable option in some cases.
This article—based on personal opinion and experience, as well as published data whenever possible—describes 10 selected aspects of operative vaginal delivery, offering recommendations for each.
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