Frontiers in pediatrics · 2025
Birth injuries in late preterm and term neonates after instrumental delivery: a prospective study on short-term and developmental outcomes.
СтатьяНазвание и аннотация: Перевод в очереди
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Elgharbawy Fawzia Mohamed, Abedin Sarfrazul, Albedaywi Rajai, Rahoma Hoda, Khatib Hakam, Khedr Abdelkhalk, Nazdaf Hakeem, Alshami Abdulla Asa'd, Habboub Lina, Bayoumi Mohammad A A, Elmalik Einas E, Gad Ashraf
Аннотация
BACKGROUND: Instrumental vaginal delivery is a common obstetric procedure with potential neonatal complications. This study evaluated birth injuries and neurodevelopmental outcomes in neonates born at ≥35 weeks' gestation following instrumental vaginal delivery.
METHODS: A prospective observational cohort conducted over 2 years (2021-2022) at Al Wakra Hospital, Qatar to assess birth injuries, neonatal intensive care unit (NICU) admission rates, and neurodevelopmental outcomes at 18 months in neonates born via instrumental delivery.
RESULTS: The study included 390 neonates born via instrumental delivery, with 84 birth injuries occurring in 80 neonates (20.5%). Cephalohematoma was the most common injury (43/84, 51.2%), followed by subgaleal hemorrhage and bone fractures (9/84, 10.7%) and intracranial hemorrhage (2/84, 2.38%). One neonatal death was associated with the combined use of vacuum and forceps. Birth injuries were more frequent with the combined use of vacuum and forceps (aOR 4.1, p < 0.001), labor induction (aOR 2.2, p = 0.010), and showed a trend toward increased risk with >3 instrument applications (aOR 2.2, p = 0.067). NICU admission occurred in 25.3% of neonates, with significantly higher rates in those delivered using both vacuum and forceps (18.2% vs. 5.8%, p < 0.001). Neurodevelopmental assessment was performed on 289 infants, of whom 28 (9.68%) had abnormal outcomes. The communication domain was most affected (67.8%, 19/28), followed by personal-social (28.6%, 8/28), fine motor (21.4%, 6/28), problem-solving (17.9%, 5/28), and gross motor skills (10.7%, 3/28). One infant was affected in all domains. The combined use of vacuum and forceps was an independent risk factor for abnormal neurodevelopmental outcomes (aOR 3.87, p = 0.019).
CONCLUSION: Instrumental vaginal delivery carries risks of birth injuries and neurodevelopmental challenges. Skilled application, careful assessment of indications, and long-term follow-up are essential to minimize complications and ensure optimal outcomes.
METHODS: A prospective observational cohort conducted over 2 years (2021-2022) at Al Wakra Hospital, Qatar to assess birth injuries, neonatal intensive care unit (NICU) admission rates, and neurodevelopmental outcomes at 18 months in neonates born via instrumental delivery.
RESULTS: The study included 390 neonates born via instrumental delivery, with 84 birth injuries occurring in 80 neonates (20.5%). Cephalohematoma was the most common injury (43/84, 51.2%), followed by subgaleal hemorrhage and bone fractures (9/84, 10.7%) and intracranial hemorrhage (2/84, 2.38%). One neonatal death was associated with the combined use of vacuum and forceps. Birth injuries were more frequent with the combined use of vacuum and forceps (aOR 4.1, p < 0.001), labor induction (aOR 2.2, p = 0.010), and showed a trend toward increased risk with >3 instrument applications (aOR 2.2, p = 0.067). NICU admission occurred in 25.3% of neonates, with significantly higher rates in those delivered using both vacuum and forceps (18.2% vs. 5.8%, p < 0.001). Neurodevelopmental assessment was performed on 289 infants, of whom 28 (9.68%) had abnormal outcomes. The communication domain was most affected (67.8%, 19/28), followed by personal-social (28.6%, 8/28), fine motor (21.4%, 6/28), problem-solving (17.9%, 5/28), and gross motor skills (10.7%, 3/28). One infant was affected in all domains. The combined use of vacuum and forceps was an independent risk factor for abnormal neurodevelopmental outcomes (aOR 3.87, p = 0.019).
CONCLUSION: Instrumental vaginal delivery carries risks of birth injuries and neurodevelopmental challenges. Skilled application, careful assessment of indications, and long-term follow-up are essential to minimize complications and ensure optimal outcomes.