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Abstract

Background: Instrumental vaginal deliveries, utilizing forceps or vacuum devices, remains a critical intervention for expediting delivery in select maternal or fetal conditions. However, these interventions carry risks of neonatal and maternal complications, most notably birth injuries.
Objective: To determine the incidence and prevalence of birth injuries in instrumental vaginal deliveries and to compare maternal and neonatal outcomes between forceps and vacuum-assisted deliveries.
Methods: This retrospective cross-sectional study analyzed 268 cases of term singleton pregnancies delivered via forceps or vacuum at our center. Data were collected on maternal demographics, comorbidities, delivery method, and outcomes. Neonatal variables included type of birth injury, need for resuscitation, NICU admission, and discharge status. Maternal outcomes such as perineal trauma, postpartum hemorrhage, and fever were also recorded. Statistical analysis was performed using SPSS 25, with Chi-square tests used to assess associations between variables.
Results: Of the 268 instrumental vaginal deliveries, vacuum extraction was more commonly employed (57.5%) than forceps (42.5%). The overall incidence of birth injuries was 19.8%, with cephalohematoma, brachial plexus injury, clavicle fracture, facial nerve palsy, intracranial hemorrhage, and skull fracture observed at low individual frequencies. Most neonates (80.2%) had no birth injury. The type of instrument used did not significantly affect the incidence or pattern of birth injuries (p = 0.730). However, the type of injury was significantly associated with neonatal outcomes at discharge (p = 0.008), with more severe injuries linked to higher rates of mortality and ongoing treatment. NICU admission was required for 54.1% of infants, with higher rates seen in those with clavicle fractures, intracranial hemorrhage, or no injury. Maternal complications-including fever (20.9%), perineal tears (20.5%), and postpartum hemorrhage (20.9%)-were evenly distributed between forceps and vacuum groups. The maternal population had a mean age of 29.86 years, with high rates of hypertension (52.2%) and diabetes (48.1%).
Conclusion: The incidence of birth injuries in instrumental vaginal deliveries at our center was 19.8%. The choice between forceps and vacuum did not significantly influence the risk or severity of neonatal injuries, resuscitation needs, NICU admissions, or maternal complications