Operative obstetrics covers a wide range of obstetric procedures from fetomaternal investigations to normal delivery to cesarean hysterectomy. For the purpose of this chapter, discussion will be confined to intrapartum events requiring assistance at vaginal delivery with forceps or vacuum extraction, shoulder dystocia and cesarean section. Operative obstetrics is a changing art. Many of the earlier concepts and procedures, especially difficult manipulation of vaginal delivery, are currently considered obsolete. Contemporary techniques and strategies are being developed and increasingly accepted. Cost-effective practice, patient demands and legal consequences of any serious injury to mother or infant are pertinent in the ideal management plan. This review of selected obstetric procedures focuses on current trends of operative delivery practice considered safe by the majority of obstetricians.