Complications néonatales des extractions instrumentales

Instrumental vaginal delivery is currently widely used among obstetrical practices and leads to significant decrease in fetal mortality and morbidity. However, these practices could be associated with several neonatal adverse effects. Very few of these complications are specific and most of them could be observed during normal vaginal delivery. Neonatal mortality is not changed by forceps or vacuum use if no other risk factors are associated. The main neonatal adverse outcomes described with both techniques are extra and intracranial haemorrhages. Usually, intra-cerebral haemorrhages have good neurological prognosis. However, few longitudinal studies are available in the literature on long term outcome of exposed newborns. Other traumatic complications observed when using forceps (facial nerve palsy, cranial skull) are not associated with long term functional consequences. Many of the most severe neonatal complications are observed when perinatal asphyxia has occurred. Extractor types and quality of use under defined criteria are closely associated with neonatal adverse outcomes in operative vaginal delivery. Forceps deliveries are as safe as vacuum deliveries to the neonate. In conclusion, operative vaginal delivery performed for maternal or fetal reasons are associated with several neonatal adverse events, usually non specific and with a short term good prognosis.