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Vacuum extraction (VE) and second\u2010stage caesarean section (SSCS) are the most commonly performed obstetric interventions, but the procedure chosen varies widely globally.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To compare maternal and perinatal morbidity, mortality and other adverse outcomes after VE versus SSCS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search Strategy<\/jats:title><jats:p>A systematic search was conducted in PubMed, Cochrane and EMBASE. Studies were critically appraised using the Newcastle\u2013Ottawa scale.<\/jats:p><\/jats:sec><jats:sec><jats:title>Selection Criteria<\/jats:title><jats:p>All artictles including women in second stage of labour, giving birth by vacuum extraction or cesarean section and registering at least one perinatal or maternal outcome were selected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Collection and Analysis<\/jats:title><jats:p>The chi\u2010square test, Fisher exact's test and binary logistic regression were used and various adverse outcome scores were calculated to evaluate maternal and perinatal outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Results<\/jats:title><jats:p>Fifteen articles were included, providing the outcomes for a total of 20\u2009051 births by SSCS and 32\u2009823 births by VE. All five maternal deaths resulted from complications of anaesthesia during SSCS. In total, 133 perinatal deaths occurred in all studies combined: 92\/20\u2009051 (0.45%) in the SSCS group and 41\/32\u2009823 (0.12%) in the VE group. In studies with more than one perinatal death, both conducted in low\u2010resource settings, more perinatal deaths occurred during the decision\u2010to\u2010birth interval in the SSCS group than in the VE group (5.5% vs 1.4%, OR\u00a04.00, 95%\u00a0CI 1.17\u201313.70; 11% vs 8.4%, OR\u00a01.39, 95%\u00a0CI 0.85\u20132.26). All other adverse maternal and perinatal outcomes showed no statistically significant differences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Vacuum extraction should be the recommended mode of birth, both in high\u2010income countries and in low\u2010 and middle\u2010income countries, to prevent unnecessary SSCS and to reduce perinatal and maternal deaths when safe anaesthesia and surgery is not immediately available.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17394","type":"journal-article","created":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T08:36:58Z","timestamp":1674203818000},"page":"586-598","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Vacuum extraction or caesarean section in the second stage of labour: A systematic review"],"prefix":"10.1111","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4417-1031","authenticated-orcid":false,"given":"Stephanie","family":"Thierens","sequence":"first","affiliation":[{"name":"Julius Global Health, The Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht Utrecht University  Utrecht The Netherlands"},{"name":"Department of Obstetrics and Gynaecology Spaarne Gasthuis  Haarlem The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8189-7726","authenticated-orcid":false,"given":"Annelien","family":"van Binsbergen","sequence":"additional","affiliation":[{"name":"Julius Global Health, The Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht Utrecht University  Utrecht The Netherlands"},{"name":"Department of Surgery Bernhoven Hospital  Bernhoven The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9542-9392","authenticated-orcid":false,"given":"Barbara","family":"Nolens","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Canisius Wilhelmina Hospital  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9890-9145","authenticated-orcid":false,"given":"Thomas","family":"van den Akker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Leiden University Medical Centre  Leiden The Netherlands"},{"name":"Athena Institute VU University  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1377-4625","authenticated-orcid":false,"given":"Kitty","family":"Bloemenkamp","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Division Women and Baby, WKZ Birth Centre University Medical Centre Utrecht Utrecht University  Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0914-5508","authenticated-orcid":false,"given":"Marcus J.","family":"Rijken","sequence":"additional","affiliation":[{"name":"Julius Global Health, The Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht Utrecht University  Utrecht The Netherlands"},{"name":"Department of Obstetrics Amsterdam University Medical Centre  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,2,8]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"World Health Organization [Internet].Trends in maternal mortality 2000 to 2017: estimates by WHO UNICEF UNFPA World Bank Group and the United Nations Population Division. 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