Efficacy of obstetrics forceps and vacuum extractor to assist during vaginal delivery: systematic review and meta-analysis

Abstract Objective: When spontaneous vaginal delivery is not feasible, Instrument-assisted vaginal delivery (IVD) is utilized, which often involves the use of vacuum extractors (VE) and obstetric forceps. This study intent to evaluate the risks and benefits associated with utilizing obstetric forceps vs vacuum extractors for IVD, focusing on maternal and neonatal outcomes. Methods: Following PRISMA guidelines, a full literature search was done in PubMed, Embase, and Google Scholar until April 2024. The review examined randomized controlled trials (RCTs) that compared forceps and vacuum extractors. Two writers extracted the data and assessed its quality separately, with a third resolving any inconsistencies. The statistical study was conducted using R software, with a random-effects model used to quantify risk differences and evaluate heterogeneity. Results: Seven RCTs, totalling 2,299 individuals, were included. A meta-analysis revealed that forceps significantly increased the incidence of perineal tears (Risk difference = 0.08, 95% CI 0.02-0.13) and vaginal injuries (Risk Difference = 0.12, 95% CI 0.05-0.19). Vacuum extractors were associated with an increased risk of infant cephalohematoma (Risk Difference = −0.06, 95% CI −0.08, −0.04). There was no significant difference in maternal anaesthesia required or failure to accomplish vaginal delivery with the intended instrument. Conclusion: Obstetric forceps are more likely to cause maternal perineal tears and vaginal injuries, whereas vacuum extractors increase the likelihood of neonatal cephalohematoma. Both methods have comparable anaesthetic needs and success rates for vaginal birth. The clinical scenario ought to guide the choice of instruments, with an emphasis on risk minimization through proper training. PROSPERO: CRD42024577839.