Assess the magnitude of adverse pregnancy outcomes and associated factors among mothers who had operative vaginal delivery in Amhara Region Comprehensive Specialized Hospitals, 2024.

A cross-sectional study was conducted from 1 November 2024 to 20 February 2025.

Seven comprehensive specialised hospitals were included in the study.

The study was employed on 389 mothers who had operative vaginal delivery.

Systematic sampling was used. Data were collected via questionnaires, chart reviews and observation. Data were entered into Epi Data V.4.6 and analysed using V.25 statistical package of social sciences. Variables with p

Adverse pregnancy outcomes of operative vaginal delivery.

Adverse pregnancy outcomes of operative vaginal delivery were 42.2%. Among them, 46 (11.8%) had only maternal complications, 55 (14.1%) had only neonatal complications and 63 (16.2%) had both maternal and neonatal complications. Perineal tear 29 (7.5%) and episiotomy extension 31 (8%) were the most common maternal complications, while caput succedaneum 45 (11.6%) was the most neonatal complication. The most common indication of operative vaginal delivery was prolonged second stage 203 (52.2%). Vacuum-assisted delivery (AOR 0.53; 95% CI 0.29 to 0.96), two tractions (AOR 2.19; 95% CI 1.23 to 3.90), birth weight less than 2.5 kg (AOR 1.85; 95% CI 1.21 to 2.83) and mid fetal station (AOR 2.9; 95% CI 1.49 to 5.64) were significantly associated with adverse pregnancy outcomes.

Adverse pregnancy outcomes following operative vaginal delivery were high. Type of instrumental vaginal delivery, number of tractions, fetal birth weight and fetal station were significantly increased risks. Therefore, operators should minimise traction attempts during operative vaginal delivery to reduce adverse outcomes.