Comparative Safety of Forceps, Vacuum, and Cesarean in Prolonged Second Stage

Abstract

Background: The second stage of labor represents a critical phase in obstetrics, where the choice of delivery mode significantly influences neonatal outcomes.

Methodology: This comparative cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Holy Family Hospital, Rawalpindi, Pakistan, from February 2023 to February 2024, to evaluate neonatal outcomes following forceps-assisted, vacuum-assisted, and emergency cesarean deliveries.

Results: A total of 100 neonates delivered during the second stage of labor were analyzed, with 42 (42%) delivered by forceps, 23 (23%) by vacuum extraction, and 35 (35%) by cesarean section. Outcomes assessed included shoulder dystocia, neonatal injuries, NICU admissions, and five-minute Apgar scores. Shoulder dystocia occurred more frequently in the vacuum group (8.2%) compared to forceps (4.8%) and cesarean (0.0%, p=0.03). Neonatal injuries were highest in vacuum deliveries (17.3%) versus forceps (4.7%) and cesarean (3.5%, p=0.04). NICU admissions were most common after cesarean (20%), followed by vacuum (17.3%) and forceps (9.5%, p=0.11). A five-minute Apgar score <7 was recorded in 14.1% of cesarean deliveries, 13.0% of vacuum, and 7.1% of forceps (p=0.21).

Conclusion: These findings suggest that forceps-assisted deliveries, when performed by skilled operators, may offer more favorable neonatal outcomes compared to vacuum extraction and emergency cesarean in prolonged second stage labor. Strengthening operator training in forceps use could optimize outcomes, particularly in resource-constrained settings.