Audit of a program to increase the use of vacuum extraction in Mulago Hospital, Uganda

Nolens, Barbara; Lule, John; Namiiro, Flavia; Roosmalen, Jos van; Byamugisha, Josaphat

doi:10.1186/s12884-016-1052-3

Cited by 32 publications

(56 citation statements)

References 29 publications

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“…Where AVD has been dropped from pre‐service or in‐service B‐EmOC training, we should understand why this has occurred. We need to learn from successful AVD reintroduction pilots in Tanzania (health centres upgraded by the World Lung Foundation's Maternal Health project to provide caesarean delivery and AVD), Uganda at the Mulago National Referral Hospital, and Ecuador at the Sotomayor Hospital in Guayaquil . Finally, much is riding on the Odon device trials that are underway; the device is a low cost technological innovation that can be used without electricity by midwives.…”

Section: Discussionmentioning

confidence: 99%

Assisted vaginal delivery in low and middle income countries: an overview

Roosmalen

Mola

et al. 2017

BJOG

127

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This study, accomplished with the use of a variety of data sources from health care facilities in a number of developing countries, demonstrates quite clearly the overall relatively low use of assisted vaginal delivery (AVD, obstetrical forceps and the vacuum extractor) in most of the facilities. The information available to the investigators did not allow an assessment of the comparative risks and benefits of AVD in these settings. Not surprising was that factors responsible for the low use of AVD were low availability of equipment and scarcity of adequately trained personnel, which varied in degree among the facilities studied. Also not unexpected was that the use of forceps delivery was much less common than assisted delivery with a vacuum extractor. Even in facilities in developed countries the rate of forceps deliveries has declined over the past three decades, with a concomitant increase in the use of the vacuum extractor (Patel et al. BMJ 2004;328:1302-5). This has occurred despite the fact that forceps deliveries are associated with fewer failures than vacuum extraction and that in cases of fetal distress, delivery can be accomplished more rapidly with forceps than with vacuum extraction. Of course, part, if not all, of the explanation for the declining use of forceps for AVD is that teaching and learning the skillful and safe use of forceps is far more difficult than learning the safe use of the vacuum extractor. This difficulty is augmented by the rise of caesarean delivery as an alternative for an attempted AVD and the decline in the number of practitioners who have sufficient experience using obstetrics forceps to be efficient teachers of the necessary skills using these instruments. Also, safe forceps delivery relies on an adequate knowledge of pelvic anatomy and a familiarity with the pros and cons of several types of forceps, neither of which is a requisite with the vacuum extractor. Evidence of this conundrum is a recent study of 5 years of deliveries (n = 5375) in an obstetric service in Mexico City in which there were only 146 forceps deliveries (i.e. approximately 29 per year) (Ayala-Y a~ nez et al. J Pregnancy 2015:489 267). Although this institution was not described as a training centre for physicians or nurse midwives, it nevertheless shows how few opportunities are available to train young practitioners in the use of forceps. Although the vacuum extractor is a reliable choice for AVD in most cases, it is of no use in a vaginal breech delivery. If spontaneous delivery of the after-coming head does not occur, the only safe alternative is the use of forceps (in most cases the Piper forceps). One of the most important conclusions of the authors of this study is the need for more comprehensive and reliable data collection in obstet-ric facilities in underdeveloped countries. This would allow an assessment of benefits and risks of AVD in these settings and a better estimate of where resources could most efficiently be directed to meet the need for more and better equipment and more trained pers...

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Section: Discussionmentioning

confidence: 99%

Assisted vaginal delivery in low and middle income countries: an overview

Roosmalen

Mola

et al. 2017

BJOG

127

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“…Although vacuum extraction is used regularly, and the hospital has a protocol with indications, the decision regarding mode of delivery depends not only on clinical factors but also on the doctor's personal preference and expertise, as well as the availability of theater and vacuum equipment. Many women undergoing cesarean delivery at Mulago National Referral Hospital could be eligible for vacuum extraction …”

Section: Methodsmentioning

confidence: 99%

“…Indications for this approach include fetal distress, prolonged second stage of labor, maternal exhaustion, or the need to avoid expulsive efforts among women with conditions such as heart failure or severe anemia . Although vacuum extraction can reduce maternal mortality from hemorrhage and sepsis—as well as perinatal mortality from birth asphyxia—use of this method has almost disappeared from obstetric practice in many LMICs . One study found that instrumental vaginal delivery was not used in almost half of 1728 Sub‐Saharan African hospitals, with usage rates below 1% in the remaining centers.…”

Section: Introductionmentioning

confidence: 99%

“…One study found that instrumental vaginal delivery was not used in almost half of 1728 Sub‐Saharan African hospitals, with usage rates below 1% in the remaining centers. Reasons for this deficit include lack of functioning equipment, lack of trained personnel, staff perceptions regarding trauma to the fetus, and fear of mother‐to‐child transmission of HIV . Consequently, many women in LMICs undergo avoidable cesarean delivery …”

Section: Introductionmentioning

confidence: 99%

“…In 2012, vacuum extraction was reimplemented in the main tertiary hospital in Uganda (Mulago National Referral Hospital, Kampala). This initiative led to declines in intrapartum stillbirths and uterine ruptures of 24% and 26%, respectively …”

Section: Introductionmentioning

confidence: 99%

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Prospective cohort study comparing outcomes between vacuum extraction and second‐stage cesarean delivery at a Ugandan tertiary referral hospital

Nolens

Namiiro

Lule

et al. 2018

Intl J Gynecology & Obste

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Predictors of adverse perinatal and maternal outcomes of instrumental vaginal delivery at a tertiary setting in Ethiopia: A cross‐sectional study

Sium

Gudu

Lucero‐Prisno

et al. 2022

Public Health Challenges

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Objective To determine the rate of instrumental vaginal delivery (IVD) and the predictors of adverse maternal and fetal outcomes associated with it in an Ethiopian setting. Methods A cross‐sectional study was conducted from October 1, 2018, to January 31, 2019, at St. Paul's Hospital Millennium Medical College (SPHMMC) (Addis Ababa, Ethiopia). Data on obstetric characteristics, perinatal and maternal outcomes of women who delivered through IVD were collected prospectively, using a structured questionnaire. Data were analyzed using SPSS version 22 and descriptive analysis was applied to analyze baseline characteristics. Multivariable logistic regression model was fitted to predict the association between short‐term complications of IVD and their determinants. Odds ratio, 95% CI, and p‐value < 0.05 were used to present significance of study findings. Results There were 3165 deliveries during the study period, out of which 241 (7.6%) were instrumental vaginal deliveries. Sequential use of instrumental delivery (AOR = 4.82 [95% CI = 2.10–27.29] and AOR = 6.43 [95% CI = 1.19–34.73], for maternal and fetal complications, respectively) was associated with increased both maternal and fetal complications. Three number of pulls during the extraction was associated with increased fetal complications (AOR = 1.19 [95% CI = 1.05–1.67]). Conclusion The rate of instrumental delivery rate in our setting is high with sequential use of instrumental delivery found to be associated with increased adverse maternal and fetal outcomes while three number of pulls were associated with increased fetal adverse outcomes.

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Audit of a program to increase the use of vacuum extraction in Mulago Hospital, Uganda

Cited by 32 publications

References 29 publications

Assisted vaginal delivery in low and middle income countries: an overview

Assisted vaginal delivery in low and middle income countries: an overview

Prospective cohort study comparing outcomes between vacuum extraction and second‐stage cesarean delivery at a Ugandan tertiary referral hospital

Predictors of adverse perinatal and maternal outcomes of instrumental vaginal delivery at a tertiary setting in Ethiopia: A cross‐sectional study

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