A comparison in maternal and neonatal outcomes between mild fundal pressure and vacuum extraction for shortening the second stage of labor

OBJECTIVE: Mild fundal pressure (MFP) and vacuum extraction (VE) are interventions used during the second stage of labor when clinical intervention is required. While VE is well established with standardized training and predictable risks, MFP remains controversial with limited comparative data. This study aimed to compare maternal and neonatal outcomes of MFP versus VE in women requiring intervention during the second stage of labor. METHODS: This is a retrospective cohort study of women with singleton term pregnancies requiring intervention during the second stage of labor at a tertiary medical center (January 2022-June 2025). Both interventions were appropriate for the same indications; the choice was at physician discretion. The primary outcome was a composite maternal outcome comprising obstetric anal sphincter injury or postpartum hemorrhage. The secondary outcome was a composite neonatal outcome including Apgar score <7 at 5 min, umbilical cord pH <7.1, birth trauma, or neonatal intensive care unit admission. RESULTS: Of 2389 women, 641 (26.8%) underwent VE and 1748 (73.2%) received MFP. The composite maternal outcome occurred in 13.7% of VE versus 8.7% of MFP (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.45-0.79). The composite neonatal outcome occurred in 10.5% of VE versus 5.2% of MFP (OR 0.47, 95% CI 0.34-0.65), driven by higher birth trauma following VE (4.2% vs. 0.7%). After adjustment, MFP was associated with lower odds of composite maternal outcome (adjusted OR [aOR] 0.56, 95% CI 0.35-0.91) and composite neonatal outcome (aOR 0.57, 95% CI 0.32-0.99). CONCLUSION: Mild fundal pressure was associated with lower odds of composite maternal and neonatal adverse outcomes compared with VE.