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Operative Obstetrics

Forceps Delivery

The frequency of forceps delivery has declined significantly as the cesarean delivery rate escalated in the last two decades. Fear of fetal injury and subsequent litigation have been at least partially responsible for this trend. Also responsible were inadequate definitions that grouped ceasarean.

Vacuum Extraction

The definitions, indications, and prerequisites for vacuum extraction of the fetus are the same as for forceps deliveries. Contraindications include face presentation.


Abdominal delivery results in a 1.5- to 7-fold increase in maternal mortality and a significant increase in morbidity, including endometritis, hemorrhage.

The four most common indications in the United States are prior dystocia, fetal distress, and breech presentation. Rate has been focused on deliveries performed for prior dystocia, account for two thirds of all abdominal deliveries. Interventions to lower the delivery rate should include encouragement for women.

Vaginal Birth After Cesarean Section

The rate of uterine separation of a single low transverse incision to be as low as 0.5-1% in women attempting vaginal birth after delivery and 1-1.3% in women with two or more low transverse incisions VBAC.

Careful review of all prior delivery operative reports is essential in counseling about the safest delivery method. Women with a prior classical or low vertical incision extending into the contractile portion of the uterus should not be allowed to go through labor. For such patients, fetal lung maturity can be confirmed.