When complications arise during the second stage of labor, clinicians must choose between continuing toward spontaneous vaginal delivery, expediting birth using an assisted vaginal birth (AVB) device, or performing an emergency second-stage cesarean section. Each option carries distinct maternal and neonatal risks. To clarify these outcomes, a large systematic review evaluated the effectiveness of AVB instruments and compared adverse events associated with AVB and second-stage cesarean delivery.
The analysis included 241 studies involving 751,242 participants. Vacuum extraction showed a significantly higher failure rate than forceps (7.60% vs 3.26%) but a lower prevalence of obstetric anal sphincter injury (4.73% vs 7.99%). Spatula use was related to fewer neonatal cephalohematomas compared with vacuum extraction (0.73% vs 5.45%) and forceps (0.73% vs 3.54%), but a higher rate of…
