Vacuum extraction or caesarean section in the second stage of labour: A systematic review

Stephanie Thierens*, Annelien van Binsbergen, Barbara Nolens, Thomas van den Akker, Kitty Bloemenkamp, Marcus J. Rijken

*Corresponding author for this work

Research output: Contribution to JournalReview articleAcademicpeer-review

Abstract

Background: Prolonged second stage of labour is an important cause of maternal and perinatal morbidity and mortality. Vacuum extraction (VE) and second-stage caesarean section (SSCS) are the most commonly performed obstetric interventions, but the procedure chosen varies widely globally. Objectives: To compare maternal and perinatal morbidity, mortality and other adverse outcomes after VE versus SSCS. Search Strategy: A systematic search was conducted in PubMed, Cochrane and EMBASE. Studies were critically appraised using the Newcastle–Ottawa scale. Selection Criteria: All artictles including women in second stage of labour, giving birth by vacuum extraction or cesarean section and registering at least one perinatal or maternal outcome were selected. Data Collection and Analysis: The chi-square test, Fisher exact's test and binary logistic regression were used and various adverse outcome scores were calculated to evaluate maternal and perinatal outcomes. Main Results: Fifteen articles were included, providing the outcomes for a total of 20 051 births by SSCS and 32 823 births by VE. All five maternal deaths resulted from complications of anaesthesia during SSCS. In total, 133 perinatal deaths occurred in all studies combined: 92/20 051 (0.45%) in the SSCS group and 41/32 823 (0.12%) in the VE group. In studies with more than one perinatal death, both conducted in low-resource settings, more perinatal deaths occurred during the decision-to-birth interval in the SSCS group than in the VE group (5.5% vs 1.4%, OR 4.00, 95% CI 1.17–13.70; 11% vs 8.4%, OR 1.39, 95% CI 0.85–2.26). All other adverse maternal and perinatal outcomes showed no statistically significant differences. Conclusions: Vacuum extraction should be the recommended mode of birth, both in high-income countries and in low- and middle-income countries, to prevent unnecessary SSCS and to reduce perinatal and maternal deaths when safe anaesthesia and surgery is not immediately available.

Original languageEnglish
Pages (from-to)586-598
Number of pages13
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume130
Issue number6
Early online date20 Jan 2023
DOIs
Publication statusPublished - May 2023

Bibliographical note

Publisher Copyright:
© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.

Funding

We would like to acknowledge the contribution of Felix Weijdema, a librarian of the University Medical Center Utrecht, who supported us with the strategy for the literature search.

FundersFunder number
University Medical Center Utrecht

    Keywords

    • caesarean section
    • maternal
    • morbidity
    • mortality
    • neonatal
    • operative vaginal delivery
    • perinatal
    • vacuum extraction

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