DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20160082

An observational study to evaluate the maternal and neonatal outcome of forceps delivery in a tertiary care government hospital of a cosmopolitan city of India

Akanksha Lamba, Ramanjeet Kaur, Zulaihuma Muzafar

Abstract


Background: Operative vaginal delivery using obstetric forceps is a practice that dates back several centuries. Modern obstetrics practice has witnessed an increase in the caesarean section rates. The goal of forceps delivery is to mimic spontaneous vaginal birth, thereby expediting delivery with a minimum of maternal or neonatal morbidity. The main objective of study was to evaluate the maternal and neonatal outcome of forceps assisted deliveries in a tertiary care hospital over a period of one year.

Methods: This retrospective observational study was done in obstetrics and gynecology department of Kasturba Hospital, Delhi from November 2014 to October 2015. Seventy cases of forceps delivery were studied for maternal outcome such as injuries, postpartum hemorrhage, need of blood transfusion and fetal outcome such as birth weight, Apgar scores at birth, neonatal intensive care unit admissions, injury, still births and neonatal mortality.

Results: 68.5% of patients requiring forceps application were primigravida. The most common indication was fetal distress (54.2%) followed by maternal exhaustion. The most common maternal complication was extension of episiotomy (10), 1 case of uterine rupture which was in a previous lower segment caesarean section case, 2 complete perineal tears, 3 cases of vaginal and cervical lacerations. Postpartum hemorrhage requiring blood transfusion occurred in 4 cases. A total of 19 babies had poor Apgar scores and 9 of them needed NICU admission. There were 3 cases of still births and 2 of early neonatal deaths.

Conclusions: The second stage interventions are associated with increased maternal and neonatal morbidity. Judicial use forceps under close supervision and with proper expertise can reduce the caesarean section rates.


Keywords


Forceps, Morbidity, Maternal outcome, Neonatal outcome

Full Text:

PDF

References


Belfort, M. Operative vaginal delivery. ACOG Practice Bulletin, 17.2000:36-9.

Demissie K, Rhoads GG, Smulian JC, Balasubramanian BA, Gandhi K, Joseph KS, et al. Operative vaginal delivery and neonatal and infant adverse outcomes: population based retrospective analysis. BMJ. 2004;329:24-9.

Al-suhel R, Gill S, Robson S, Shadbolt B. Kjelland’s forceps in the new millennium. Maternal and neonatal outcomes of attempted rotational forceps delivery. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2009;49:510-4.

Villar J, Carroli G, Zavaleta N, Donner A, Wojdyla D, Faundes A. Maternal and neonatal individual risks and benefits associated with caesarean delivery: Multicentre prospective study. BMJ. 2007;335(7628):1025.

Lumbiganon P, Laopaiboon M, Gülmezoglu AM, Souza JP, Taneepanichskul S, Ruyan P, et al. Method of delivery and pre- gnancy outcomes in Asia: The WHO global survey on maternal and perinatal health 2007-08. Lancet. 2010;375(9713): 490-9.

Akhtar S. Comparison of maternal and infant outcome between vacuum extraction and forceps deliveries. Pakistan Armed Force Medical Journal. 2006;2(1):25-31.

Archanna S, Monga D. Outcome of forceps delivery versus vacuum extraction—a review of 200 cases. Singapore Med J. 1994;35(6):605-8.

Yeomans ER. Operative vaginal delivery. Obstet Gynecol. 2010;115:645-53.

Singh A, Rathore P. A comparative study of feto-maternal outcome in instrumental vaginal delivery. J Obstet Gynaecol India. 2011;61:663-6.

Johnson JH, Figueroa R, Garry D, Elimian A, Maulik D. Immediate maternal and neonatal effects of forceps and vacuum-assisted deliveries. Obstet Gynecol. 2004;103(3):513-8.

Nkwabong E, Nana PN, Mbu R, Takang W, Ekono MR, Kouam L. Indications and maternofetal outcome of instrumental deliveries atthe University Teaching Hospital of Yaounde, Cameroon. Trop Doct. 2011;41:5-7.

Eskander O, Shet D. Risk factors for third and fourth degree perineal tear. J Obstet gynecol. 2009;29(2):119-22.

Bollard RC, Gardiner A, Duthie GS, Lindow SW. Anal sphincter injury, fecal and urinary incontinence: A 34-year follow-up aft er forceps delivery. Dis Colon Rectum. 2003;46:1083-8.

Sahu L. A 10 year analysis of uterine rupture at a teaching institution. J Obstet Gynecol India. 2006;56(6):502-6.

Royal College of Obstetricians & Gynaecologists. Birth after previous caesarean birth. Guideline No. 45. London: RCOG; 2007.

Shamsa A, Jun Bai J, Raviraj P, Gyaneshwar R. Mode of delivery and its associated maternal and neonatal outcomes. Open Journal of Obstetrics and Gynecology. 3 2013;3:307-12.

WuWen S, Shiliang L, Kramer SM, Marcoux S, Ohlsson A, Sauvé R, et al. Comparison of maternal and infant outcomes between vacuum extraction and forceps deliveries. Am J Epidemiol. 2001;153:103-7.

Garrett K, Butler A, Cohen WR. Caesarean delivery during second-stage labor: characteristics and diagnostic accuracy. J Matern Fetal Neonatal Med. 2005;17(1):49-53.