Maternal and neonatal outcomes in vacuum assisted births in the government tertiary care hospital in Mandya: a retrospective record-based study
Keywords:Forceps, Instrumental deliveries, Neonatal intensive care unit, Perinatal complications, Vacuum
Background: Vacuum extraction and forceps are the two options when an instrument is needed to facilitate a vaginal birth. Vacuum extraction has recently gained popularity because of new designs of vacuum cups with reduced risk of injury to the neonate. Vacuum extraction is one of the evidence-based interventions that can prevent complications by shortening the second stage of labour. The present study has been carried out to evaluate the maternal and neonatal morbidity, mortality and failure associated with vacuum assisted vaginal deliveries, at a Government tertiary care hospital in Mandya, Karnataka, India.
Methods: The study was a record-based study including a total of 207 women who underwent vaginal assisted delivery in the form of vacuum assisted deliveries in a period of 6 months from January 2019 to June 2019 at the Government tertiary care hospital in Mandya, Karnataka, India. Records of women who had vacuum assisted deliveries and records of their newborn children were accessed.
Results: In our study 41.5% of the subjects were in the age group of 21-25 years. Nearly 3/4th (74.4%) of the subjects were primigravida. More than half (54.1%) of the study subjects had to be put under vacuum assisted techniques for delivery because of the prolonged second stage of labour, failure rate was 0.4%. Out of 207 vacuum assisted deliveries maternal complication rate was 8.21%, 17.3% neonates had NICU admission and 14.97% had perinatal complications.
Conclusions: Vacuum assisted vaginal delivery is comparatively a better choice in preventing the complications caused due to prolonged second stage of labour thus reducing the cesareans rate. It is a safe alternative to cesareans delivery in rightly chosen case. Vacuum assisted delivery by a skilled person and a proper technique is associated with lesser maternal and neonatal morbidity.
Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe J. Operative vaginal delivery. In: Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe J, eds. Williams Obstetrics. 24th ed. New York, NY: McGraw-Hill Education; 2014:574-586.
American College of Obstetricians and Gynecologists. Practice Bulletin No.154: Operative vaginal delivery. Obstet Gynecol. 2015;126:e56-65.
Prapas N, Kalogiannidis I, Masoura S. Operative vaginal delivery in singleton term pregnancies: short-term maternal and neonatal outcomes. Hippokratia. 2008;13(1):41-5.
Nolens, Lule J, Namiiro F, van Roosmalen J, Byamugisha J. Audit of a program to increase the use of vacuum extraction in Mulago Hospital, Uganda Barbara. BMC Preg Childbirth. 2016;16:258.
Shameel F, Bava A, Nandanwar YS. Instrumental vaginal deliveries at tertiary centre. Int J Reprod Contracept Obstet Gynecol. 2016;5:4146-50.
Jeon J, Sunghun NA. Vacuum extraction vaginal delivery: current trend and safety. Obstet Gynecol Sci. 2017;60(6):499-505.
McQuivey RW. Vacuum-assisted delivery: a review: J Maternal-Fetal Neonat Med. 2004;16:171-9.
Chaudhari P, Bansal N, Gupta V, Tandon A, Chaudhry A. A comparative study of feto-maternal outcome in instrumental vaginal delivery at tertiary health level hospital in Uttarakhand state. Int J Reprod Contracept Obstet Gynecol. 2016;5:3294-9.
Ajit V. Assisted delivery. Pract Obstet Gynecol. APC Publications. 2016:216.
Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. Global, regional and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:980-1004.
Hofmeyr GJ. Obstructed labor: using better technologies to reduce mortality. Int J Gynaecol Obstet. 2004;85 Suppl1:S62-72.
Mbaruku G, van Roosmalen J, Kimondo I, Bilango F, Bergstrom S. Perinatal audit using the 3-delays model in western Tanzania. Int J Gynaecol Obstet. 2009;106:85-8.
Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 154: Operative Vaginal Delivery. Obstet Gynaecol. 2015;126(5):e56-65.
Green-top guideline no. 26: Operative vaginal delivery. Royal College of Obstetricians and Gynaecologists, 2011. Available at: http://www.rcog.org.uk/globalassets/documents/guidelines/gtg_26.pdf. Accessed on 3rd February 2016.
Ministry of Health, Uganda. Uganda safe motherhood life-saving skills trainin. In: Trainees’ handbook. The Republic of Uganda: Reproductive Health Division, MOH; 2012.
Nolens B, Lule J, Namiiro F, Roosmalen JV, Byamugisha J. Audit of a program to increase the use of vacuum extraction in Mulago Hospital, Uganda. BMC Preg Childbirth. 2016;16:258.
Unzila AA, Errol RN. Vacuumy. Reviews in OBG. 2009;2(1):5-17.
Jason B, Deirdre L, Yasser ES, Amen N, Megan F, Caterine B, et al. Maternal morbidity after forceps vs vacuum assisted delivery - outcomes from a large state-wide cohort. Am J Obstet Gynecol. 2018;218(1):S345.
Jason B, Deirdre L, Yasser ES, Amen N, Megan F, Caterine B, et al. Neonatal outcomes after operative vaginal delivery - are forceps or vacuum safer? Am J Obstet Gynecol. 2018;218(1):S343.
Shrestha BK, Shrestha B, Thapa B. Vacuum assisted vaginal delivery in singleton term pregnancies: short term maternal and neonatal outcome in a tertiary hospital of Nepal. J Lumbini Med Coll. 2016;4(2):104-7.
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(7456):24.
Prameela RC, Prajwal S. Assisted vaginal delivery, Forceps, Ventouse. Outcome of instrumental vaginal deliveries in referred cases. J Evolut Med Dent Sci. 2015;4(19):3275-80.