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Operative vaginal delivery

Elisabeth K Wegner, MD
Ira M Bernstein, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG


Operative vaginal delivery refers to a delivery in which the operator uses forceps or a vacuum device to extract the fetus from the vagina, with or without the assistance of maternal pushing. The decision to use an instrument to deliver the fetus balances the maternal, fetal, and neonatal impact of the procedure against the alternative options of cesarean birth or expectant management.


In the United States, 3.2 percent of all deliveries in 2014 were accomplished via an operative vaginal approach [1]. Forceps deliveries accounted for 0.57 percent of vaginal births and vacuum deliveries accounted for 2.64 percent of vaginal births. However, there is a wide range in use of operative vaginal delivery both across and within geographic regions in the United States (1 to 23 percent) which suggests that evidence-based guidelines for operative vaginal delivery are either inadequate or randomly applied or familiarity and expertise with the technique is declining [2].


Use of forceps or vacuum is reasonable when an intervention to terminate labor is indicated and operative vaginal delivery can be safely and readily accomplished; otherwise, cesarean delivery is the better option.

We agree with an American College of Obstetricians and Gynecologists practice bulletin that considered protracted second stage of labor, suspicion of immediate or potential fetal compromise, and shortening the second stage for maternal benefit appropriate indications for operative vaginal delivery (forceps or vacuum) [3]. However, no indication is absolute, and cesarean delivery is also an option in these clinical settings.

Although one can never be certain of a successful outcome, we attempt an operative vaginal delivery when we believe success is likely, since the rate of birth trauma may be higher after failed attempts at operative delivery [4,5]. The decision to proceed with operative vaginal delivery is ongoing and decided moment by moment based on assessment of the success of the various steps in the procedure. Preprocedure risk factors do not accurately predict whether an operative vaginal delivery attempt will fail [6].


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Literature review current through: Feb 2017. | This topic last updated: Fri Dec 09 00:00:00 GMT+00:00 2016.
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