Reported Outcomes for Assisted Vaginal Birth: A Systematic Review

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Background: Assisted vaginal birth (AVB) remains a frequent intervention in labour. However, outcome reporting and definitions vary widely, partly due to a lack of a core outcome set (COS). This renders data aggregation and comparison of procedures challenging. Objectives: To systematically catalogue all procedural, maternal, and neonatal outcomes reported in contemporary AVB literature, quantify their reporting frequency, and describe definitions used, to form the basis for development of COS for AVB. Search strategy: A comprehensive search of MEDLINE, Embase and Cochrane Library was conducted to identify studies published between January 2001 and September 2025. Selection criteria: Studies reporting outcomes related to use of forceps, vacuum and spatula were eligible. Studies including ≥30 participants, in any healthcare setting, published in any language were included. Data collection and analysis: Two reviewers independently conducted study selection, data extraction and quality assessment, with narrative synthesis undertaken. Outcomes were grouped into procedural, maternal, and neonatal domains, with frequencies and definitions documented. Main results: 206 studies were included. Maternal perineal trauma, neonatal birth injuries, Apgar scores, and neonatal intensive care admission were most frequently reported. Procedural outcomes including AVB success and failure were inconsistently described. Definitions for outcomes varied widely. Long term maternal and neonatal outcomes were infrequently reported. Conclusion: Outcome reporting in AVB research is highly heterogeneous, with substantial variation in outcome definitions. This lack of standardisation limits evidence synthesis and complicates clinical interpretation. These findings provide a foundation for developing a COS for AVB to improve reporting consistency and support future research and clinical decision-making.

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