Impact of Different Delivery Modalities on Maternal and Neonatal Outcomes During Prolonged Deceleration in the Second Stage of Labor: A Retrospective Study.

OBJECTIVE

To investigate the effects of three delivery methods-vacuum extraction, forceps-assisted delivery, and cesarean section-on maternal and neonatal outcomes during prolonged deceleration (PD) in the second stage of labor, providing evidence-based support for clinical decision-making.

METHODS

This retrospective cohort study analyzed 114 singleton, term pregnancies with vertex presentation experiencing PD in the second stage of labor between January 2022 and December 2024. Participants were categorized by delivery method: vacuum extraction (n=62), forceps delivery (n=30), and cesarean section (n=22). Primary outcomes included maternal morbidity indicators (eg, blood loss, hospital stay) and neonatal outcomes (eg, umbilical artery pH, NICU admission).

RESULTS

The cesarean section group had a higher fetal station, a longer deceleration-to-delivery interval, and significantly increased maternal morbidity, including longer postpartum hospital stay, higher costs, extended antibiotic use and catheterization, and greater blood loss compared to instrumental delivery groups (all P < 0.05). The forceps group had a higher incidence of wound erythema than the cesarean group (P < 0.05). Critically, neonatal outcomes were comparable across all three groups (P > 0.05).

CONCLUSION

During PD in the second stage of labor, both operative vaginal delivery and cesarean section present a trade-off between maternal morbidity and procedural expediency. The choice of delivery method should be individualized, based on a rapid assessment of fetal station, labor progress, and operator expertise, as neonatal short-term outcomes were similar regardless of the mode of delivery.