Operative vaginal delivery and emergency cesarean section are critical interventions used in the second stage of labor when fetal distress threatens maternal or neonatal well-being. Prompt recognition of fetal compromise and timely decision-making are essential to ensure safe delivery outcomes while minimizing complications for both mother and baby. The aim of this study is to compare maternal and neonatal outcomes between operative vaginal delivery and emergency cesarean section in cases of fetal distress occurring during the second stage of labor. This is a retrospective cohort study involving pregnant women conducted at a tertiary care center between 2012 and 2024. A total of 397 pregnant women diagnosed with fetal distress in the second stage of labor were included. The operative vaginal delivery group comprised 302 patients, while the emergency cesarean delivery group included 95 patients who underwent emergency cesarean delivery for fetal distress. Maternal and neonatal outcomes were compared. Neonatal outcomes constituted the primary endpoints of the study. Analysis of neonatal outcomes demonstrated that the operative vaginal delivery group had significantly lower median Apgar scores at both 1 min (6; range 0–8) and 5 min (8; range 4–10). Furthermore, this group exhibited higher incidences of neonatal intensive care unit admission ( n = 96, 30.7%), respiratory distress ( n = 25, 8.2%), requirement for phototherapy ( n = 28, 9.2%), meconium aspiration syndrome ( n = 51, 16.9%), cephalohematoma ( n = 21, 6.73%), and caput succedaneum ( n = 99, 33%). Additionally, one neonate had facial paralysis; six had brachial plexus injuries; three had clavicular fractures; three had periorbital hematomas; three had intracranial hemorrhage; and one had pneumothorax. There was no significant difference between the groups in the incidence of intracranial hemorrhage or hypoxic-ischemic encephalopathy. Bladder injury and surgical site infection were significantly more common in the emergency cesarean delivery group, whereas vaginal lacerations were more frequent in the operative vaginal delivery group. Operative vaginal delivery is significantly associated with adverse neonatal outcomes compared with emergency cesarean delivery. However, maternal complications were more common following emergency cesarean section.
Tosun et al. (2026) studied this question.