| Assessment | May be suitable for OVD in the delivery room | Consider OVD in theatre | Consider ceasarean section |
|---|---|---|---|
| Position | <45 degrees rotation from OA | >45 degrees rotation from OA | - |
| Station | Station +1 or below, if all other findings favourable | Spines or +1 | Above spines. Mid cavity if other unfavourable findings |
| Moulding | Nil / + | + / ++ | +++ |
| Caput | Nil / + | + / ++ | +++ |
| Descent with contractions and pushing | Good | Minimal | None |
| Ease of rotation of fetal head with pushing or VE | Easy rotation | Some rotation | No rotation |
| Birth canal/pelvic dimensions | Subjective - adequate pelvis | Subjective - adequate pelvis | Subjective - pelvis may not be adequate |
| Fetal status (pathological CTG/low scalp pH) | The choice of delivery option depends on the operator's expertise. Aim for a delivery that is quickest and safest for mother and baby. | ||
Higher rates of failure are also associated with:
- maternal body mass index >30
- estimated fetal weight >4000 g or clinically big baby.
A senior obstetrician should decide on the venue for a mid-cavity/rotational delivery, or the option of proceeding directly to caesarean section. The presence of antenatal and intrapartum risk factors should favour delivery in theatre.