|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.