BJOG. 2023 Jan 20. doi: 10.1111/1471-0528.17394. Online ahead of print.
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 common performed obstetric interventions, but which procedure is used varies widely globally.
OBJECTIVE: 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.
ANALYSIS: Chi-square test, Fisher exact test and binary logistic regression were used and various Adverse Outcome Scores were calculated to evaluate maternal and perinatal outcomes.
RESULTS: 15 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, 92/20051 (0.45%) in the SSCS group and 41/32823 (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 decision-to-birth interval (DBI) in the SSCS group than in the VE group (5.5% vs. 1.4%, OR 4.00 (95%CI 1.17-13.70 and 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.
CONCLUSION: VE should be the recommended mode of birth both in HIC as in LMIC to prevent unnecessary SSCS and decrease perinatal and maternal deaths when safe anaesthesia and surgery is not immediately available.
PMID:36660890 | DOI:10.1111/1471-0528.17394
