**3.4 Contraindications for operative vaginal delivery**

Operative vaginal delivery is not permitted in some circumstances [8]. Contraindications include unengaged fetal head, unknown fetal position and certain fetal disorders such as hemophilia. In particular, Vacuum extraction is contraindicated in preterm pregnancies of less than 34 weeks of gestation. This is because risk of intra-ventricular hemorrhage is high [10].

## **3.5 Complications of operative vaginal delivery**

Operative vaginal delivery poses some complications both to the mother and the baby [8]. The major complications are maternal injuries, fetal injuries and hemorrhage. These are common in particularly if the doctor or midwife is inexperienced or if the mother is not appropriately chosen. Significant maternal perineal trauma and neonatal bruising are more common with forceps delivery whereas shoulder dystocia, cephalohematoma, jaundice and retinal bleeding are more common with vacuum-assisted delivery.
