| Full abdominal and vaginal examination | Head is less than a fifth palpable per abdomen Cervix is fully dilated and the membranes ruptured Vertex presentation Exact position of the head can be determined so proper placement of the instrument can be achieved Assessment of caput and moulding Pelvis is deemed adequate. Irreducible moulding may indicate cephalo–pelvic disproportion |
|---|---|
| Preparation of mother | Clear explanation should be given and informed consent obtained Asepsis Appropriate analgesia Maternal bladder emptied recently. In-dwelling catheter should be removed or balloon deflated |
| Preparation of staff | Operator must have the knowledge, experience and skill necessary Adequate facilities available (appropriate equipment, bed and lighting) Consider venue (i.e. room or theatre) Back-up plan in place in case of failure to deliver Anticipation of complications that may arise (e.g. shoulder dystocia or postpartum haemorrhage) Personnel trained in neonatal resuscitation should be present |
