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    Subjects/OBG/Instrumental Delivery — Forceps, Vacuum
    Instrumental Delivery — Forceps, Vacuum
    hard
    baby OBG

    A 32-year-old multipara at term is in active labor. After 1 hour of pushing in the second stage, the fetal head is at station +1 with the occiput in the right occiput anterior (ROA) position. Contractions are strong and regular. Fetal heart rate is 135 bpm with reduced variability. The obstetrician attempts vacuum extraction but detachment occurs twice despite correct application and traction. What is the most appropriate next step?

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