Use of Forceps or Ventouse at 33 Weeks Gestation
Forceps or ventouse should NOT be used for operative vaginal delivery at 33 weeks gestation due to the extreme prematurity and high risk of significant neonatal trauma, particularly intracranial and subgaleal hemorrhage with vacuum extraction. At this gestational age, if vaginal delivery cannot be achieved spontaneously, cesarean delivery is the safer alternative.
Critical Safety Concerns at 33 Weeks
The use of instrumental delivery at 33 weeks poses unacceptable risks:
- Vacuum extraction at preterm gestations has the potential to cause significant fetal injury, including intracranial and subgaleal hemorrhage 1
- The preterm skull is more fragile and susceptible to trauma from instrumental forces 1
- Neonates at 32-33 weeks have significantly higher rates of NICU admission and neonatal complications compared to those born at 34 weeks or later 2
When Instrumental Delivery Might Be Considered
The only context where forceps or ventouse are mentioned in preterm delivery relates to term or near-term pregnancies with specific maternal cardiac conditions:
- Low forceps or vacuum extraction may assist delivery in laboring women with cardiovascular disease to avoid the Valsalva maneuver 1
- This recommendation applies to maternal indications at term, not to routine preterm deliveries 1
Appropriate Management at 33 Weeks
If expedited delivery is needed at 33 weeks:
- Cesarean delivery should be strongly considered as the primary mode of delivery, particularly for fetal indications 3, 4
- For fetal growth restriction with absent end-diastolic velocity at 33-34 weeks, cesarean delivery is recommended due to 75-95% rates of intrapartum fetal heart rate decelerations requiring emergency cesarean 3, 4
Essential pre-delivery interventions at 33 weeks:
- Administer antenatal corticosteroids (delivery anticipated before 33 6/7 weeks) 1, 3, 4
- Administer magnesium sulfate for neuroprotection (pregnancies <32 weeks) 3, 4
- Ensure immediate neonatal resuscitation capacity is available 1
- Coordinate care with neonatology 4
Common Pitfall to Avoid
Do not attempt instrumental delivery simply because the fetal head is low or because you want to avoid cesarean section at 33 weeks. The neonatal risks of instrumental trauma at extreme prematurity far outweigh any potential maternal benefits of avoiding cesarean delivery 1, 2. Neonatal survival at 32-33 weeks is excellent (95%) with cesarean delivery when indicated 4.