A primigravida with veex presentation is having fully dilated cervix. Head is well engaged and is having a station of +2. Foetal hea monitoring shows late deceleration. Most appropriate management in such a case would be: September 2009

Ans. C: Forceps Application Criteria for types of forceps deliveries: Outlet forceps: - The scalp is visible at the introitus, without separating the labia. The fetal skull has reached the pelvic floor. - The sagittal suture is in anteroposterior diameter, right or left occiput anterior or posterior position (ie, the fetal head is at or on the perineum and rotation does not exceed 45deg). Low forceps: The leading point of the fetal skull is at a station greater than or equal to +2 cm and is not on the pelvic floor; any degree of rotation may be present. Mid forceps: The station is above +2 cm, but the head is engaged. High forceps: Previous systems classified high-forceps deliveries as procedures performed when the head is not engaged. High-forceps deliveries are not recommended. The following indications apply to use of forceps, when no contraindications exist: Prolonged second stage: This includes nulliparous woman with failure to deliver after 2 hours without, and 3 hours with, conduction anesthesia. It also includes multiparous woman with failure to deliver after 1 hour without, and 2 hours with, conduction anesthesia. Suspicion of immediate or potential fetal compromise in the second stage of labor. Shoening of the second stage for maternal benefits: Maternal indications include, but are not limited to, exhaustion, bleeding, cardiac or pulmonary disease, and history of spontaneous pneumothorax. In skilled hands, fetal malpositions, including the after-coming head in breech vaginal delivery, can be indications for forceps delivery. Prerequisites for forceps delivery include the following: The head must be engaged. The cervix must be fully dilated and retracted. The position of the head must be known. Clinical assessment of pelvic capacity should be performed. No dispropoion should be suspected between the size of the head and the size of the pelvic inlet and mid pelvis. The membranes must be ruptured. The patient must have adequate analgesia. The operator should be competent in the use of the instruments