> The risks of operative delivery must be weighed against the consequences of awaiting vaginal birth or alternatively performing a caesarean section with the head deep in the pelvis (RANZCOG 2009a)
> In cases where there is an anticipated higher risk of failed operative delivery, the procedure should be considered a trial and be conducted in the operating theatre with recourse to caesarean section if unsuccessful
> Obtain consent for proceeding to caesarean section if unsuccessful
> Other procedures that may become necessary during operative delivery include:
> Manual rotation before forceps or ventouse delivery
> Episiotomy
> Manoeuvres for should dystocia
> Caesarean section
> Repair of perineal tear
> Clinicians should separate serious from frequently occurring risks (see table I). Higher rates of failure and serious or frequent complications are associated with:
> Higher maternal body mass index
> Ultrasound estimated fetal weight > 4,000 g or clinically large baby
> Occipitoposterior position
> Mid-cavity delivery or when 1/5 fetal palpable abdominally