Impact of Different Delivery Modalities on Maternal and Neonatal Outcomes: A Comparative Study of Vacuum Extraction, Forceps Delivery, and Cesarean Section During Prolonged Deceleration in the Second Stage of Labor
Introduction:
The global fertility rate is declining, emphasizing the strategic importance of improving the childbirth experience to enhance fertility intentions and address negative population growth. With the widespread adoption of electronic fetal monitoring (EFM), clinicians can better identify fetal heart rate deceleration patterns. Prolonged deceleration (PD) is defined as a decrease in fetal heart rate of 15 beats per minute (bpm) or more below the baseline, lasting for at least 2 minutes but less than 10 minutes. If it persists for 10 minutes or longer, it is classified as a baseline change. The primary mechanisms involve fetal myocardial hypoxia and vagal reflexes. The clinical management of PD remains contentious. Some experts advocate for active intervention and expedited delivery, while others suggest that not all PD episodes require immediate cesarean section, especially when caused by reversible factors.
Methodology:
This single-center retrospective observational study was conducted at Nanning Second People’s Hospital. It included singleton, vertex-presenting pregnancies at ≥34 weeks gestation who experienced PD in the second stage of labor between January 2022 and December 2024. PD was defined as a fetal heart rate deceleration of ≥15 bpm below baseline, lasting ≥2 minutes but <10 minutes, occurring after full cervical dilation.
Results:
The study found that cesarean section was associated with a longer interval from deceleration to delivery, significantly increased postpartum blood loss, prolonged hospitalization, and higher medical costs. However, the fewer deceleration episodes recorded in this group suggest that the decision for surgical intervention may have been made at an earlier stage of the fetal heart rate abnormality.
Discussion:
The study highlights a distinct trade-off between vacuum extraction, forceps delivery, and cesarean section. Operative vaginal delivery (vacuum extraction and forceps) significantly shortened the duration of potential fetal compromise and reduced maternal trauma and faster recovery. However, forceps delivery was linked to a higher incidence of perineal wound erythema. The lower pre-delivery hemoglobin level observed in the vacuum extraction group may indicate underlying baseline differences.
The study emphasizes that there is no single universally optimal delivery method for managing PD in the second stage of labor. The cornerstone of clinical decision-making lies in a rapid, structured assessment, prioritizing operative vaginal delivery when fetal station is low and operator expertise is sufficient, and opting for cesarean section when conditions are unfavorable for vaginal birth.
Conclusion:
This study underscores the importance of individualized clinical decision-making, emphasizing the need for comprehensive evaluation of fetal station, labor progress, fetal tolerance, maternal condition, and operator experience to select the most appropriate approach for rapid and safe delivery.
