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Trend, Prevalence, and Associated Factors of Unfavorable Fetal Outcomes Following Operative Vaginal Delivery in Ethiopia: A Systematic Review and Meta-Analysis.
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Abstract
Introduction: Although rare, operative vaginal delivery (OVD) can lead to various fetal/neonatal complications, particularly in resource-limited settings. Numerous factors have been identified as being associated with unfavorable fetal outcomes following OVD. However, studies examining unfavorable outcomes were highly varied and inconsistently reported in Ethiopia. Therefore, this systematic review and meta-analysis aims to estimate the trend, pooled prevalence, and its associated factors of unfavorable fetal outcomes following to OVD. Methods: All pertinent articles released before September 2024, were methodically gathered from scientific data bases (PubMed, Hinari, Scopus, web of science, Science direct and Google scholar).The Joanna Briggs institute tool was used to assess the quality of the study. Data were extracted in Microsoft excel 2013 format and analyzed using Stata software version 17. Results: The meta-analysis of eight studies revealed, a lower odds of unfavorable fetal outcomes among mothers who gave birth by OVD with prolonged labor than those with other indication (pooled odd ratios (POR): 0.4, 95% CI: 0.04, 0.84); vacuum delivery (POR: 0.3, 95% CI: 0.0407, 0.53); birth weight (POR: 0.42, 95% CI: 0.15, 0.68); and delivery attendant (POR: 0.4, 95% CI: 0.14, 0.94). The pooled prevalence of unfavorable fetal outcomes among mothers who gave birth by OVD in Ethiopia was 29% (95%: CI: 22, 35); (I2 = 91.74%, p < 0.01). Conclusion: The pooled prevalence of unfavorable fetal outcomes following OVD was high in Ethiopia. Prolonged second stage of labor, use of vacuum as type of OVD, birth weight, and the type of delivery attendant were the factors associated with unfavorable fetal outcomes. Therefore, we recommend the ministry of health and other stakeholders to emphasize the identified modifiable factors to further reduce unfavorable fetal outcome following OVD among mothers who gave birth in Ethiopia. Systematic Review Registration: CRD42024561713.
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