{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:29:43Z","timestamp":1791462583882,"version":"4.3.4"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T00:00:00Z","timestamp":1743724800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Instrumental vaginal delivery is a common obstetric procedure with potential neonatal complications. This study evaluated birth injuries and neurodevelopmental outcomes in neonates born at \u226535 weeks\u2019 gestation following instrumental vaginal delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A prospective observational cohort conducted over 2 years (2021\u20132022) 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), labor induction (aOR 2.2, <jats:italic>p<\/jats:italic>\u2009=\u20090.010), and showed a trend toward increased risk with &amp;gt;3 instrument applications (aOR 2.2, <jats:italic>p<\/jats:italic>\u2009=\u20090.067). 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%, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). 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, <jats:italic>p<\/jats:italic>\u2009=\u20090.019).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1569513","type":"journal-article","created":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T08:53:42Z","timestamp":1746521622000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Birth injuries in late preterm and term neonates after instrumental delivery: a prospective study on short-term and developmental outcomes"],"prefix":"10.3389","volume":"13","author":[{"given":"Fawzia Mohamed","family":"Elgharbawy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarfrazul","family":"Abedin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajai","family":"Albedaywi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoda","family":"Rahoma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hakam","family":"Khatib","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelkhalk","family":"Khedr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hakeem","family":"Nazdaf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulla Asa'd","family":"Alshami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Habboub","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad A. A.","family":"Bayoumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Einas E.","family":"Elmalik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraf","family":"Gad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"7423475","DOI":"10.1155\/2018\/7423475","article-title":"Prevalence and outcome of operative vaginal delivery among mothers who gave birth at Jimma University medical center, southwest Ethiopia","volume":"2018","author":"Hubena","year":"2018","journal-title":"J Pregnancy"},{"key":"B2","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1007\/s13224-012-0282-1","article-title":"A prospective randomized study comparing maternal and fetal effects of forceps delivery and vacuum extraction","volume":"63","author":"Shekhar","year":"2013","journal-title":"J Obstet Gynaecol India"},{"key":"B3","doi-asserted-by":"publisher","first-page":"CD005455","DOI":"10.1002\/14651858.CD005455.pub2","article-title":"Choice of instruments for assisted vaginal delivery","volume":"11","author":"O'Mahony","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"B4","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.ejogrb.2022.10.028","article-title":"Assisted vaginal birth using the paily obstetric forceps vs. ventouse\u2014a randomized clinical trial","volume":"280","author":"Burande","year":"2023","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"B5","volume-title":"Forceps Delivery","author":"Evanson","year":"2025"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e70","DOI":"10.1111\/1471-0528.16092","article-title":"Assisted vaginal birth: green-top guideline no. 26","volume":"127","author":"Murphy","year":"2020","journal-title":"BJOG"},{"key":"B7","first-page":"1","article-title":"Births: final data for 2015","volume":"66","author":"Martin","year":"2017","journal-title":"Natl Vital Stat Rep"},{"key":"B8","doi-asserted-by":"publisher","first-page":"526.e1","DOI":"10.1016\/j.ajog.2007.01.024","article-title":"Variation in the rates of operative delivery in the United States","volume":"196","author":"Clark","year":"2007","journal-title":"Am J Obstet Gynecol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e2453292","DOI":"10.1001\/jamanetworkopen.2024.53292","article-title":"Obstetric outcomes by hospital volume of operative vaginal delivery","volume":"8","author":"Willy","year":"2025","journal-title":"JAMA Netw Open"},{"key":"B10","doi-asserted-by":"publisher","first-page":"264","DOI":"10.3109\/01443610903572109","article-title":"Caesarean section in the second stage of labour: a retrospective review of obstetric setting and morbidity","volume":"30","author":"McKelvey","year":"2010","journal-title":"J Obstet Gynaecol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"20503121221113091","DOI":"10.1177\/20503121221113091","article-title":"Complications of instrumental vaginal deliveries and associated factors in hospitals of Western Oromia, Ethiopia","volume":"10","author":"Shimalis","year":"2022","journal-title":"SAGE Open Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"16S","DOI":"10.1097\/AOG.0000000000003431","article-title":"Simulation training for operative vaginal delivery among obstetrics and gynecology residents: a systematic review","volume":"134","author":"Bligard","year":"2019","journal-title":"Obstet Gynecol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"843147","DOI":"10.3389\/fped.2022.843147","article-title":"Neonatal simulation program: a 5 years educational journey from Qatar","volume":"10","author":"Bayoumi","year":"2022","journal-title":"Front Pediatr"},{"key":"B14","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1186\/s12884-023-06080-9","article-title":"Maternal complications and risk factors associated with assisted vaginal delivery","volume":"23","author":"Chawanpaiboon","year":"2023","journal-title":"BMC Pregnancy Childbirth"},{"key":"B15","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.ejogrb.2011.06.043","article-title":"Instrumental delivery: clinical practice guidelines from the French college of gynaecologists and obstetricians","volume":"159","author":"Vayssiere","year":"2011","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"355.e1","DOI":"10.1016\/j.ajog.2014.10.023","article-title":"Management of fetal malposition in the second stage of labor: a propensity score analysis","volume":"212","author":"Aiken","year":"2015","journal-title":"Am J Obstet Gynecol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"627810","DOI":"10.1155\/2015\/627810","article-title":"Determinants and outcomes of emergency caesarean section following failed instrumental delivery: 5-year observational review at a tertiary referral centre in London","volume":"2015","author":"McDonnell","year":"2015","journal-title":"J Pregnancy"},{"key":"B18","volume-title":"Current Diagnosis and Treatment: Obstetrics and Gynecology","author":"DeCherney","year":"2013"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1635","DOI":"10.1186\/s12889-024-19149-7","article-title":"Neonatal mortality and associated factors among newborns in Mogadishu, Somalia: a multicenter hospital-based cross-sectional study","volume":"24","author":"Ali","year":"2024","journal-title":"BMC Public Health"},{"key":"B20","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1186\/s12905-023-02224-3","article-title":"Prevalence, indications and fetal outcomes of operative vaginal delivery in sub-Saharan Africa, systematic review, and meta-analysis","volume":"23","author":"Mebratu","year":"2023","journal-title":"BMC Womens Health"},{"key":"B21","doi-asserted-by":"publisher","first-page":"11960","DOI":"10.1038\/s41598-024-62703-x","article-title":"Neonatal complications and risk factors associated with assisted vaginal delivery","volume":"14","author":"Chawanpaiboon","year":"2024","journal-title":"Sci Rep"},{"key":"B22","first-page":"105","article-title":"Late preterm: high risk newborns despite appearances","volume":"75","author":"Snyers","year":"2020","journal-title":"Rev Med Liege"},{"key":"B23","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1055\/s-0035-1571150","article-title":"Short- and long-term outcomes of moderate and late preterm infants","volume":"33","author":"Natarajan","year":"2016","journal-title":"Am J Perinatol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1016\/j.arcped.2019.10.005","article-title":"Neurodevelopmental outcome of late-preterm infants: literature review","volume":"26","author":"Favrais","year":"2019","journal-title":"Arch Pediatr"},{"key":"B25","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1097\/GCO.0000000000000221","article-title":"Rotational vaginal delivery with kielland\u2019s forceps: a systematic review and meta-analysis of effectiveness and safety outcomes","volume":"27","author":"Al Wattar","year":"2015","journal-title":"Curr Opin Obstet Gynecol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1097\/AOG.0000000000001156","article-title":"Maternal and neonatal outcomes by attempted mode of operative delivery from a low station in the second stage of labor","volume":"126","author":"Halscott","year":"2015","journal-title":"Obstet Gynecol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"E1","DOI":"10.1503\/cmaj.210841","article-title":"Maternal and neonatal trauma following operative vaginal delivery","volume":"194","author":"Muraca","year":"2022","journal-title":"CMAJ"},{"key":"B28","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1097\/AOG.0b013e3182749ac9","article-title":"Mode of delivery at term and adverse neonatal outcomes","volume":"121","author":"Walsh","year":"2013","journal-title":"Obstet Gynecol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1097\/AOG.0b013e31823835d3","article-title":"Mode of delivery in nulliparous women and neonatal intracranial injury","volume":"118","author":"Werner","year":"2011","journal-title":"Obstet Gynecol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015-3496","article-title":"Developmental outcomes of late preterm infants from infancy to kindergarten","volume":"138","author":"Shah","year":"2016","journal-title":"Pediatrics"},{"key":"B31","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.jpeds.2021.02.066","article-title":"Neonatal morbidities in infants born late preterm at 35\u201336 weeks of gestation: a Swedish nationwide population-based study","volume":"233","author":"Mitha","year":"2021","journal-title":"J Pediatr"},{"key":"B32","volume-title":"Birth Asphyxia","author":"Gillam-Krakauer","year":"2025"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1086","DOI":"10.1111\/ped.13990","article-title":"Psychometric profile of the ages and stages questionnaires, Japanese translation","volume":"61","author":"Mezawa","year":"2019","journal-title":"Pediatr Int"},{"key":"B34","doi-asserted-by":"publisher","first-page":"e073991","DOI":"10.1136\/bmj-2022-073991","article-title":"Maternal and neonatal trauma during forceps and vacuum delivery must not be overlooked","volume":"383","author":"Muraca","year":"2023","journal-title":"Br Med J"},{"key":"B35","doi-asserted-by":"publisher","first-page":"E734","DOI":"10.1503\/cmaj.171076","article-title":"Ecological association between operative vaginal delivery and obstetric and birth trauma","volume":"190","author":"Muraca","year":"2018","journal-title":"CMAJ"},{"key":"B36","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1186\/s12884-021-04124-6","article-title":"Maternal and neonatal outcomes in mothers with diabetes mellitus in Qatari population","volume":"21","author":"Bayoumi","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"B37","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.ejogrb.2013.08.015","article-title":"Increasing rates of operative vaginal delivery across two decades: accompanying outcomes and instrument preferences","volume":"171","author":"Hehir","year":"2013","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1016\/j.anpedi.2018.11.016","article-title":"Short-term neonatal outcomes of vacuum-assisted delivery. A case-control study","volume":"91","author":"Ferraz","year":"2019","journal-title":"An Pediatr (Engl Ed)"},{"key":"B39","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1016\/j.ejogrb.2006.10.002","article-title":"Effect of instrument preference for operative deliveries on obstetrical and neonatal outcomes","volume":"134","author":"Abenhaim","year":"2007","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"B40","doi-asserted-by":"publisher","first-page":"8","DOI":"10.69614\/ejrh.v11i3.307","article-title":"Assessment of neonatal outcome of operative vaginal delivery and its determinants at Dilla University referral hospital, south Ethiopia","volume":"11","author":"Feyisso Shaka","year":"2019","journal-title":"Ethiop J Reprod Health"},{"key":"B41","doi-asserted-by":"publisher","first-page":"78","DOI":"10.29054\/apmc\/2014.383","article-title":"Comparison of maternal and neonatal outcome in forceps versus ventouse assisted vaginal delivery","volume":"8","author":"Tanveer","year":"2014","journal-title":"Ann Punjab Med Coll"},{"key":"B42","first-page":"41","article-title":"Operative vaginal delivery in singleton term pregnancies: short-term maternal and neonatal outcomes","volume":"13","author":"Prapas","year":"2009","journal-title":"Hippokratia"},{"key":"B43","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1007\/s00540-012-1480-9","article-title":"Effects of epidural analgesia on labor length, instrumental delivery, and neonatal short-term outcome","volume":"27","author":"Hasegawa","year":"2013","journal-title":"J Anesth"},{"key":"B44","doi-asserted-by":"publisher","first-page":"100324","DOI":"10.1016\/j.xagr.2024.100324","article-title":"Comparative effects of epidural analgesia and intramuscular morphine on maternal and neonatal outcomes: a retrospective cohort study","volume":"4","author":"Elsayed","year":"2024","journal-title":"AJOG Glob Rep"},{"key":"B45","doi-asserted-by":"publisher","first-page":"292","DOI":"10.18203\/2320-1770.ijrcog20160082","article-title":"An observational study to evaluate the maternal and neonatal outcome of forceps delivery in a tertiary care government hospital of a cosmopolitan city of India","volume":"5","author":"Lamba","year":"2016","journal-title":"Int J Reprod Contracept Obstet Gynecol"},{"key":"B46","doi-asserted-by":"publisher","first-page":"e002048","DOI":"10.1136\/bmjpo-2023-002048","article-title":"Long-term neurodevelopmental outcome in children born after vacuum-assisted delivery compared with second-stage caesarean delivery and spontaneous vaginal delivery: a cohort study","volume":"7","author":"Stefhanie","year":"2023","journal-title":"BMJ Paediatrics Open"},{"key":"B47","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1111\/ajo.12952","article-title":"Implications of vaginal instrumental delivery for children\u2019s school achievement: a population-based linked administrative data study","volume":"59","author":"Hsieh","year":"2019","journal-title":"Aust N Z J Obstet Gynaecol"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1569513\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T08:53:44Z","timestamp":1746521624000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1569513\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,4]]},"references-count":47,"alternative-id":["10.3389\/fped.2025.1569513"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1569513","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,4]]},"article-number":"1569513"}}