A 5-year retrospective review of instrumental vaginal deliveries in Uyo, Akwa Ibom State, Nigeria

Trends and Determinants of Operative Vaginal Delivery at Two Academic Hospitals in Johannesburg, South Africa 2005–2019

“…Furthermore, the likelihood of having OVDs generally decreases with age. This finding may be related to the fact that young parturient are likely to be nulliparous with uterine inertia and untested or rigid pelvis [ 15 ]. Moreover, our study also revealed that the odds of OVDs decreases with increasing parity.…”

“…Thus, in order to reduce primary and subsequent repeat caesarean sections among young nulliparous women, the availability of a skilled accoucheur that can perform OVDs among well selected patients cannot be over-emphasized. Similarly younger women and nulliparous women had higher likelihood of having forceps delivery as compared to vacuum delivery, possibly because of exhaustion during prolonged second stage [ 15 , 41 , 42 ].…”

“…Many studies attributed declining trends of OVD rates in low and middle income countries (LMICs) to lack of appropriate skills and equipment, fear of litigation, poor supervision of junior or inexperienced birth attendants, and lack of relevant local guidelines and policies to entrench OVDs [ 1 , 3 , 6 , 7 , 8 , 14 , 15 ]. In South Africa, another contributory reason to downward trend to OVD rates was linked to previous guidelines of the prevention of mother to child transmission of HIV(PMTCT) program that discouraged use of vacuum among HIV positive patients [ 3 , 7 ].…”

“…There is also a misconception that instrumental delivery may be associated with increased risk of brain injury to the baby [ 3 , 7 , 16 ]. The most common instrument for OVD procedures in both LMICs and HICs is vacuum (as compared to forceps [ 6 , 15 , 17 , 18 ]. Thus, the vacuum extraction rate in LMICs is 3.9%, while forceps rate is 0.2% [ 6 ].…”

“…The aforementioned may impact on the trends in maternity and intrapartum care in the country [ 3 ]. Additionally, there is a notion that junior doctors prefer performing caesarean section in place of OVD because of lack of requisite skills [ 6 , 7 , 8 , 14 , 15 ]. The evidence of the current trends in OVD rates with its associated factors at the largest maternity centers in South Africa (Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Chris Hani Baragwaneth Academic Hospital (CHBAH)) is not available.…”