The Perinatal and Maternal Outcomes of Instrumental Vaginal Delivery

Perinatal & Maternal Outcomes of Instrumental Vaginal Delivery


  • Ahmed Alwazzan Department of Obstetrics and Gynecology, King Abdulaziz University · Jeddah, Saudi Arabia



Instrumental Vaginal Delivery, Perinatal, Maternal, Vacuum, Forceps


Instrumental vaginal delivery is necessary under special circumstances to facilitate a safer delivery process. Objective: To assess the perinatal and maternal outcomes of instrumental vaginal delivery. Methods: This retrospective study was conducted at King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia and included patients from July 2018-June 2021. All females with singleton pregnancy who underwent instrumental delivery using vacuum or forceps were included. Data were analyzed using SPSS 19. Results: There was a total of 346 instrumental delivery cases during these three years, out of which 337 (97.4%) were vacuum and 9 (2.6%) were forceps. A significant difference was observed between both groups regarding 3rd & 4th-degree tears and hospital stay, where the mean hospitalization and the rate of 3rd & 4th-degree tears were higher among forceps groups than the vacuum group (4.1±2.8 forceps vs 2.1±1.0vacuum, p value<0.0001) and (44.4% forceps vs 9.5% vacuum, p value=0.009) respectively. There was a significant difference between the two groups regarding Apgar score at 1 m and Apgar score at 5 m, where the means of both Apgar scores were higher among the vacuum group than the forceps group (8.1±1.6 vacuum vs 6.4±3.2 forceps, p value=0.002) and (9.5±1.3 vacuum vs 8.3±3.2 forceps, p value=0.006) respectively. Conclusions: It is critical to renovate the training and use of operative vaginal delivery to improve these skills which is underutilized today. When it is performed by a skilled provider it is a perfect alternative to Caesarean delivery in the chosen patients.



Jeon J and Na S. Vacuum extraction vaginal delivery: current trend and safety. Obstetrics & Gynecology Science. 2017 Nov; 60(6): 499-505. doi: 10.5468/ogs.2017.60.6.499.

Caughey AB, Cahill AG, Guise JM, Rouse DJ, American College of Obstetricians and Gynecologists. Safe prevention of the primary cesarean delivery. American Journal of Obstetrics and Gynecology. 2014 Mar; 210(3): 179-93. doi: 10.1016/j.ajog.2014.01.02.

The American College of Obstetricians and Gynecologists. Safe Prevention of the Primary Cesarean Delivery. Obstetrics Care Consensus. 2014 Mar; 1: 1-19.

John L, Nischintha S, Ghose S. Outcome of forceps delivery in a teaching hospital: A 2 year experience. Journal of Natural Science, Biology and Medicine. 2014 Jan; 5(1): 155. doi: 10.4103/0976-9668.127316.

Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Medicine. 2018 Jan; 15(1): e1002494. doi: 10.1371/journal.pmed.1002494.

Chikazawa K, Takagi K, Takahashi H, Akashi K, Nakamura E, Samejima K, et al. Introduction of forceps delivery education for residents at a single perinatal institution. Hypertension Research in Pregnancy. 2016 Nov; 4(2): 102-5. doi: 10.14390/jsshp.HRP2016-006.

National Institute for Health and Clinical Excellence. Caesarean Section: Clinical Guide- line 132. 2011. [Last Cited: 8th Jan 2018]. Available from:

Gholitabar M, Ullman R, James D, Griffiths M. Caesarean section: summary of updated NICE guidance. BMJ. 2011 Nov; 343: d7108. doi: 10.1136/bmj.d7108.

UNICEF, WHO, UNFPA. Guidelines for monitoring the availability and use of obstetric services. 1997. [Last cited: 8th Jan 2018]. Available from:

Ba'aqeel HS. Cesarean delivery rates in Saudi Arabia: a ten-year review. Annals of Saudi medicine. 2009 May; 29(3): 179-83. doi: 10.4103/0256-4947.51773.

ACOG Practice Bulletin No. 154. Operative Vaginal Delivery. Obstetrics Gynecology. 2015 Nov; 126(5): e56-e65. doi: 10.1097/AOG.0000000000001147.

Chaudhari P, Bansal N, Gupta V, Tandon A, Chaudhry A. A comparative study of feto-maternal outcome in instrumental vaginal delivery at tertiary health level hospital in Uttarakhand state. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2016 Oct; 5(10): 3294-300. doi: 10.18203/2320-1770.ijrcog20163169.

Çetin BA, Bahat PY, Köroğlu N, Konal M, Akça A. Comparison of maternal and neonatal outcomes of operative vaginal deliveries: vacuum vs. forceps. Istanbul Medical Journal. 2017 Dec; 18: 196-9. doi: 10.5152/imj.2017.27122.

Johanson RB, Rice C, Doyle M, Arthur J, Anyanwu L, Ibrahim J, et al. A randomised prospective study comparing the new vacuum extractor policy with forceps delivery. BJOG: an International Journal of Obstetrics & Gynaecology. 1993 Jun; 100(6): 524-30. doi: 10.1111/j.1471-0528.1993.tb15301.x.

Jabeen N, Baloch R, Malhi P, Zahiruddin S, Mawani K. Foeto-maternal outcome in instrumental vaginal delivery attending a secondary hospital in Hyderabad (Aga Khan Maternal and Child Care Centre). Journal of Pakistan Medical Association. 2017 Dec; 67(12): 1833.

Mesleh RA, Al-Sawadi HM, Kurdi AM. Comparison of maternal and infant outcomes between vacuum extraction and forceps deliveries. Practice. 2002 Jul; 3: 4.

Garba JA, Burodo AT, Saidu AD, Sulaiman B, Umar AG, Ibrahim R, et al. Instrumental vaginal delivery in Usmanu Danfodiyo University Teaching Hospital, Sokoto: A ten‑year review. Tropical Journal of Obstetrics and Gynaecology. 2018 Oct; 35(2): 123-7. doi: 10.4103/TJOG.TJOG_13_18.

Faisal S, Bava A, Nandanwar YS. Instrumental vaginal deliveries at tertiary centre. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2016 Dec; 5(12): 4146-51. doi: 10.18203/2320-1770.ijrcog20163997.

Aliyu LD, Kadas AS, Hauwa MA. Instrumental vaginal delivery in bauchi, northeast Nigeria. Journal of the West African College of Surgeons. 2011 Oct; 1(4): 18.

Prapas N, Kalogiannidis I, Masoura S, Diamanti E, Makedos A, Drossou D, et al. Operative vaginal delivery in singleton term pregnancies: short-term maternal and neonatal outcomes. Hippokratia. 2009 Jan; 13(1): 41.

Singh A and Rathore P. A comparative study of feto-maternal outcome in instrumental vaginal delivery. The Journal of Obstetrics and Gynecology of India. 2011 Dec; 61: 663-6. doi: 10.1007/s13224-011-0119-3.

ACOG Practice Bulletin, Number 219. Operative Vaginal Birth. Obstetrics Gynecology. 2020; 135(4): 149-159. doi: 10.1097/AOG.0000000000003764.

Angioli R, Gómez-Marín O, Cantuaria G, O’Sullivan MJ. Severe perineal lacerations during vaginal delivery: the University of Miami experience. American Journal of Obstetrics and Gynecology. 2000 May; 182(5): 1083-5. doi: 10.1067/mob.2000.105403.

Bradley MS, Kaminski RJ, Streitman DC, Dunn SL, Krans EE. Effect of rotation on perineal lacerations in forceps-assisted vaginal deliveries. Obstetrics and Gynecology. 2013 Jul; 122(1): 132. doi: 10.1097/AOG.0b013e31829752fc.

Johanson R and Menon V. Vacuum extraction versus forceps for assisted vaginal delivery. Cochrane database of systematic reviews. 2000; (2): CD000224. doi: 10.1002/14651858.CD000224.



DOI: 10.54393/pjhs.v4i01.283
Published: 2023-01-31

How to Cite

Alwazzan, A. (2023). The Perinatal and Maternal Outcomes of Instrumental Vaginal Delivery: Perinatal & Maternal Outcomes of Instrumental Vaginal Delivery. Pakistan Journal of Health Sciences, 4(01), 155–160.



Original Article