Kasbaoui et al reported criteria for a difficult extraction at delivery. The authors are from Strasbourg University in France.

Criteria for extraction difficulty - one or more of the following:

(1) operative vaginal delivery considered difficult by the operator

(2) >= 2 more vacuum device detachments (if vacuum device used)

(3) need to apply a second instrument

(4) extraction time > 10 minutes

(5) need for an internal obstetrical maneuver to disengage the shoulders

(6) cesarean section for extraction failure


Risk factors for difficult extraction:

(1) perineal to skull ultrasound distance (PSUD) > 40 mm

(2) birth weight > 4,000 grams

(3) presentation posterior or transverse

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