Background: Operative or assisted vaginal delivery (OVD) is a vaginal birth in which an instrument is needed to facilitate the delivery and is accomplished using a vacuum device or forceps. Over 700 different types of obstetrical forceps have been known so far in history. Both vacuum and forceps deliveries require a skilled and experienced obstetrician. Objective: the aim of the study is to assess the outcomes of assessted vaginal delivery (ventouse and forceps) in Saudi Arabia. Methodology: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, this systematic review was carried out. Results: the overall outcomes of both ventouse and forceps on both mother and neonate are similar with some special differences for each instrument, vacuum-assisted vaginal deliveries were associated with significant fetal morbidity, including scalp lacerations, cephalohematomas, subgaleal hematomas, intracranial hemorrhage, facial nerve palsies, hyperbilirubinemia, and retinal hemorrhage. While forceps delivery were associated with perineal lacerations, vaginal lacerations, and hematomas, anal sphincter injury, long term complication of pelvic organ prolapse and also affect the fetus by facial lacerations, facial nerve injury, ocular trauma, skull fracture, intracranial hemorrhage, subgaleal hematoma, hyperbilirubinemia, fetal death. Conclusion: There were high rates of trauma following forceps and vacuum deliveries, documented across regions, levels of obstetric care and hospitals. Operative vaginal delivery (OVD) is considered safe if carried out by trained personnel so that appropriate use of both the forceps and vacuum extractor is an essential skill that should be maintained to keep Caesarean section rates in check.