Comparative Risk of Neonatal Ischemic Encephalopathy in Operative Vaginal Delivery versus Cesarean Section at...

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Perinatal Research

Background:

• Neonatal hypoxic-ischemic encephalopathy (HIE) is a serious complication of childbirth.
• Operative vaginal delivery (OVD), including vacuum and forceps-assisted births, is sometimes necessary when spontaneous vaginal delivery (SVD) is not possible.
• Comparing HIE risks across different delivery methods is crucial for optimizing neonatal outcomes.

Purpose of the Study:

• To evaluate the association between operative vaginal delivery (OVD) and neonatal hypoxic-ischemic encephalopathy (HIE) risk.
• To compare OVD with spontaneous vaginal delivery (SVD) and cesarean delivery at complete cervical dilation (CDCD).
• To conduct subgroup analyses for vacuum-assisted and forceps-assisted deliveries.

Main Methods:

• A systematic literature search was conducted across multiple databases (PubMed, Cochrane Library, Web of Science, Medline, ClinicalTrials.gov, Scopus) up to October 1, 2024.
• Included are cohort studies comparing HIE incidence in OVD versus CDCD or SVD, adhering to PRISMA guidelines.
• Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models.

Main Results:

• Five studies encompassing 141,774 deliveries were analyzed.
• OVD was linked to a significantly higher risk of HIE compared to SVD (RR 3.36, 95% CI 2.52-4.50).
• No significant difference in HIE risk was found between OVD and CDCD (RR 0.77, 95% CI 0.50-1.19). Forceps-assisted delivery showed a lower HIE risk than CDCD (RR 0.29, 95% CI 0.15-0.43), whereas vacuum-assisted delivery did not differ significantly (RR 0.89, 95% CI 0.56-1.42).

Conclusions:

• Operative vaginal delivery is associated with an increased risk of HIE compared to spontaneous vaginal delivery, but not cesarean delivery at complete cervical dilation.
• Forceps-assisted delivery may be associated with a reduced risk of HIE relative to cesarean delivery at complete cervical dilation, unlike vacuum-assisted delivery.
• Careful selection of delivery method is essential when spontaneous vaginal delivery is not feasible, balancing maternal and neonatal risks to improve outcomes.