OG37.6 | Outlet Forceps, Vacuum and Breech Delivery Observation — Summary & Reflection

KEY TAKEAWAYS

Assisted delivery (OG37.6) covers outlet forceps, vacuum extraction, and vaginal breech delivery. Prerequisites for instrumental delivery ('ABCDE'): Adequate analgesia, Bladder empty, Cervix fully dilated, Descent and position confirmed, Equipment ready including neonatal team. Wrigley's forceps: left blade first, then right blade, lock, check application, traction with contractions following pelvic curve (Pajot's), disarticulate as head crowns. Vacuum: cup at flexion point (3 cm anterior to posterior fontanelle on sagittal suture), pressure build-up gradually, traction with contractions; abandon after 3 pop-offs or 3 pulls without progress. Breech types: frank (65%, most suitable for vaginal), complete (10%), footling (25%, highest cord prolapse risk). Key breech principle: hands off until umbilicus delivered. Manoeuvres: Lovset's for extended arms; Burns-Marshall or MSV for after-coming head — MSV fingers on malar bones (not mandible). TERM Breech Trial 2000: planned CS better than planned vaginal breech at term — current standard. Complications: maternal (perineal tears I-IV, cervical lacerations, PPH), neonatal (cephalhaematoma, subgaleal haemorrhage, chignon, Erb's palsy). Sequential instrument use is contraindicated.

REFLECT

After observing an assisted delivery, take 10 minutes for structured reflection. (1) What was the single most important clinical finding that led to the decision to perform instrumental delivery — and could it have been managed differently earlier in labour? (2) At what point during the procedure were you most uncertain about what was happening, and how would you clarify that uncertainty before your next observation? (3) If you had been the operator, which step would you have found most technically challenging, and what practice could you use to prepare for it? Reflection after assisted deliveries is particularly important because these are high-stakes, time-critical procedures where technical decisions are made under pressure — understanding the decision logic as well as the technique is what makes a good obstetrician.