Instrumental vaginal deliveries at tertiary centre

Abstract

Background: Operative vaginal delivery has been maligned since the days of W. J. Little with the word “Forceps” becoming synonymous with the “Birth Injury” and “Cerebral palsy”. Instrumental vaginal deliveries in that era were the end result of a long, obstructed labour performed for maternal benefits and to avoid destructive procedures to the fetus. The aims and objectives of the study were to find out the incidence of instrumental vaginal delivery at our tertiary institute and to know the indications of the procedure and to study the impacts of the same on maternal and fetal outcomes.

Methods: This was as observational prospective cohort study on Instrumental Vaginal Deliveries (IVD) carried out between Jan 2015 to Dec 2015 at a tertiary hospital in Sion, Mumbai. All the patients who had an instrumental vaginal delivery were studied in terms of maternal age, parity, indications for the same, maternal and fetal outcomes, APGAR scoring, NICU admissions and complications in both.

Results: The incidence of Instrumental vaginal delivery was 2.8% of all deliveries, most of the patients between 20- 30yrs (88%) and maximum primigravida (57.19%). In 70.56 % patients it was indicated because of prolonged second stage of labour. 2 patients required blood transfusion, other complications being cervical tear (36 cases) and extension of episiotomy (27 cases). 82 newborn babies had birth asphyxia for which NICU admission was required.

Conclusions: It is evident from our study that Instrumental Vaginal Delivery is an important emergency obstetrics procedure in our obstetrics day to day care. It is very important to make Instrumental Vaginal Delivery procedure available and accessible everywhere especially in low resource country like India where the need is high and caesarean section as alternative is not always available. It should be made available for such patient with abnormal prolonged labour and complication should be identified and managed at the earliest.