Birth Injuries in Late Preterm and Term Neonates After Instrumental Delivery: A Prospective Study on Short-Term and Developmental Outcomes

Fawzia Mohamed Elgharbawy Sarfrazul Abedin Rajai Albedaywi Hoda Rahoma Hakam Khatib Abdelkhalk Khedr Hakeem Nazdaf Abdulla Asa'd Alshami Lina Habboub Mohammad A. A. Bayoumi ^* Einas Elmalik Ashraf Gad

• Hamad Medical Corporation, Doha, Qatar

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 haemorrhage and bone fractures (9/84, 10.7%) and intracranial haemorrhage (2/84, 2.38%). Birth injuries were more frequent with the combined use of vacuum and forceps (aOR 4.1, p <0.001), labour 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). 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. Simulation-based training, skilled application, careful assessment of indications, and long-term follow-up are essential to minimize complications and ensure optimal outcomes.