Failed ventouse at full dilatation — procedural decision station

Procedural decision station on assisted vaginal birth: candidate must recognise a high-risk mid-cavity rotational attempt, choose a trial in theatre, run the prerequisites, apply the abandonment rules, manage a failed ventouse with an impacted head, and complete the post-procedure package. Includes assessor timeline, marking domains, assessor key and fail criteria.

Prompt

A 29-year-old G1P0 at 41+1 weeks, induced for post-dates, has been fully dilated for two hours with 75 minutes of active pushing under epidural. The CTG shows recurrent late decelerations with reduced variability. You examine: fully dilated, membranes ruptured, station plus 1, position right occipitoposterior, caput plus plus, moulding plus, one fifth palpable abdominally. Estimated fetal weight 4.0 kg, maternal body mass index 33. You are the registrar; the consultant is in the building.

Station brief

Format. Procedural decision station, approximately 12 minutes. A midwife and an anaesthetist are with you; the consultant is in the building and reachable. The assessor runs the clock and feeds you new findings. Verbalise every decision and every check. ^[1]

Candidate instruction. Decide where and how this birth should happen, run the safety checks aloud, perform or abandon the attempt according to explicit rules, and manage the consequences. ^[1]

References7Show

[1]Murphy DJ, Strachan BK, Bahl R, et al. Assisted Vaginal Birth: Green-top Guideline No. 26 BJOG, 2020.PMID 32346983
[2]Murphy DJ, Liebling RE, Verity L, et al. Early maternal and neonatal morbidity associated with operative delivery in second stage of labour: a cohort study Lancet, 2001.PMID 11675055
[3]Bahl R, Van de Venne M, Macleod M, et al. Maternal and neonatal morbidity in relation to the instrument used for mid-cavity rotational operative vaginal delivery: a prospective cohort study BJOG, 2013.PMID 23924292
[4]Gardella C, Taylor M, Benedetti T, et al. The effect of sequential use of vacuum and forceps for assisted vaginal delivery on neonatal and maternal outcomes Am J Obstet Gynecol, 2001.PMID 11641674
[5]Waterfall H, Grivell RM, Dodd JM Techniques for assisting difficult delivery at caesarean section Cochrane Database Syst Rev, 2016.PMID 26827159
[6]Knight M, Chiocchia V, Partlett C, et al. Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial Lancet, 2019.PMID 31097213
[7]Doumouchtsis SK, Arulkumaran S Head trauma after instrumental births Clin Perinatol, 2008.PMID 18280876

Failed ventouse at full dilatation — procedural decision station

Station brief

Candidate instruction. Decide where and how this birth should happen, run the safety checks aloud, perform or abandon the attempt according to explicit rules, and manage the consequences. ^[1]

References7Show

[1]Murphy DJ, Strachan BK, Bahl R, et al. Assisted Vaginal Birth: Green-top Guideline No. 26 BJOG, 2020.PMID 32346983
[2]Murphy DJ, Liebling RE, Verity L, et al. Early maternal and neonatal morbidity associated with operative delivery in second stage of labour: a cohort study Lancet, 2001.PMID 11675055
[3]Bahl R, Van de Venne M, Macleod M, et al. Maternal and neonatal morbidity in relation to the instrument used for mid-cavity rotational operative vaginal delivery: a prospective cohort study BJOG, 2013.PMID 23924292
[4]Gardella C, Taylor M, Benedetti T, et al. The effect of sequential use of vacuum and forceps for assisted vaginal delivery on neonatal and maternal outcomes Am J Obstet Gynecol, 2001.PMID 11641674
[5]Waterfall H, Grivell RM, Dodd JM Techniques for assisting difficult delivery at caesarean section Cochrane Database Syst Rev, 2016.PMID 26827159
[6]Knight M, Chiocchia V, Partlett C, et al. Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial Lancet, 2019.PMID 31097213
[7]Doumouchtsis SK, Arulkumaran S Head trauma after instrumental births Clin Perinatol, 2008.PMID 18280876