Operative vaginal delivery (OVD) — vaginal birth assisted with forceps or vacuum — is used in the second stage of labor to expedite delivery for maternal or fetal indications. When performed by skilled clinicians, OVD can improve outcomes but also carries risk of neonatal complications ranging from soft tissue trauma to severe neurologic injury and NICU admission. Global and country-level OVD rates vary; in Ethiopia previously reported OVD rates range from about 7% to 16.9%. Despite the potential for both benefit and harm, limited data exist from Northwest Ethiopia on the frequency and predictors of adverse neonatal outcomes after OVD.
To determine the prevalence of adverse neonatal outcomes and identify factors associated with these outcomes among births delivered by operative vaginal delivery at the University of Gondar Comprehensive Specialized Hospital (UoGCSH) in Northwest Ethiopia.
Study design and setting: A facility-based retrospective cross-sectional review of medical records was conducted at UoGCSH in Gondar. The hospital recorded 19,634 deliveries over the two-year period from September 1, 2019 to August 30, 2021; 719 of those were operative vaginal deliveries.
Population and sampling: The source population included all mothers who underwent OVD at UoGCSH during the study period. After applying exclusion criteria (stillbirths, neonates with lethal congenital anomalies, multiple births, and records with incomplete documentation of key variables), a sample size of 303 OVD cases was derived using a single-population proportion formula (prior prevalence 13.2%, 95% confidence, 4% margin of error, plus 10% non-response). A computer-generated simple random sampling technique selected 303 operative vaginal deliveries from the identified 719.
Data collection and variables: Data were extracted from maternal and neonatal medical records using a semi-structured questionnaire adapted from previous studies and pilot-tested. Collected variables included maternal sociodemographic features, obstetric history, intrapartum findings (including presence and grade of meconium-stained amniotic fluid), mode and indication for OVD, and neonatal outcomes.
Analysis: Data entry used Epi-Data v3.1 and analysis was performed in IBM SPSS v24. Descriptive statistics summarized participant characteristics and neonatal outcomes. Bivariable logistic regression identified candidate variables (p < 0.25) for inclusion in multivariable logistic regression. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported; statistical significance in the multivariable model was set at p < 0.05.
Sample characteristics: The study reviewed 303 mothers who underwent OVD. The mean maternal age was 25.19 years (SD ± 4.7). All participants were married; 154 (50.8%) had a college education or higher.
Prevalence of adverse neonatal outcomes: The overall prevalence of adverse neonatal outcomes following operative vaginal delivery was 23.1% (95% CI: 18.68–28.21).
Independent predictors: In multivariable logistic regression, the presence and severity of meconium-stained amniotic fluid (MSAF) and primigravidity were independently associated with adverse neonatal outcomes. Specifically, MSAF grade 1/2 was associated with increased odds (AOR = 4.13, 95% CI: 1.96–8.69) and MSAF grade 3 with markedly higher odds (AOR = 24.9, 95% CI: 6.14–46.06). Primigravidity was also associated with higher odds of adverse outcomes (AOR = 2.49, 95% CI: 1.13–5.16).
Additional analytic details, including bivariable results and the full set of variables considered, are reported in the article tables and supporting files.
This facility-based review identified a substantial prevalence of adverse neonatal outcomes following operative vaginal delivery at UoGCSH. The observed 23.1% prevalence exceeds the prior prevalence estimate used for sample size calculation (13.2% from Jimma University Medical Center) and indicates a significant burden of neonatal complications in this OVD cohort.
The strong, graded association between MSAF and adverse neonatal outcomes underscores the clinical importance of meconium during labor. Grade 3 MSAF, in particular, carried a substantially higher adjusted odds ratio compared with lower grades, suggesting more severe meconium is a key risk marker for neonatal compromise after OVD. The independent association between primigravidity and adverse outcome suggests first pregnancies may have a higher risk profile for neonatal complications in the context of OVD at this center.
The authors emphasize that careful intrapartum monitoring and timely obstetric decision-making are critical, especially for primigravid women and when MSAF is present. They note that appropriate use of forceps and vacuum extraction by skilled providers can reduce neonatal complications, but that patient selection and close monitoring remain essential.
In this retrospective review of 303 operative vaginal deliveries at the University of Gondar Comprehensive Specialized Hospital, adverse neonatal outcomes occurred in nearly one quarter of cases (23.1%). Presence and severity of meconium-stained amniotic fluid and primigravidity were independently associated with increased odds of adverse neonatal outcomes. The authors recommend strengthened intrapartum surveillance and early obstetric intervention for women with MSAF and for primigravid mothers to reduce neonatal morbidity related to OVD.
Note: The rewritten text reports the study methods, sample, prevalence, and associations exactly as presented in the source article. Additional numeric breakdowns and specific neonatal outcome categories are available in the article tables and supporting information cited by the authors.