Birthing experience and quality of life after vacuum delivery and second‐stage caesarean section: a prospective cohort study in Uganda

Nolens, Barbara; Akker, Thomas van den; Lule, John; Twinomuhangi, Sulphine; Roosmalen, Jos van; Byamugisha, Josaphat

doi:10.1111/tmi.13089

Cited by 17 publications

(19 citation statements)

References 31 publications

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“…In case they had experienced the procedure, they clearly preferred this intervention above CS. These results are in line with previous findings from the same setting: 91% of the women after vacuum extraction were satisfied about their birthing experience [19]. A study from Argentina found that only 6% of the healthy pregnant nulliparous women (without indication for CS) in the public sector preferred CS above vaginal birth [33].…”

Section: Discussionsupporting

confidence: 91%

“…Reasons for choosing vacuum extraction in our study are supported by results of studies in the same setting [15,19]: after vacuum extraction, compared to after CS, pain scores were lower up to 6 weeks after birth and more women were able to work at 6 weeks after birth [19]. Vacuum extraction was indeed safer for the mother [15]: risk of severe maternal complications (maternal death, uterine rupture while waiting for procedure, hysterectomy and re-laparotomy) was 0.8% (3/358) in women who had had (trial of) vacuum extraction as compared to 4.2% (18/425) in women who had undergone second stage CS.…”

Section: Discussionsupporting

confidence: 63%

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Women's recommendations: vacuum extraction or caesarean section for prolonged second stage of labour, a prospective cohort study in Uganda

Nolens

Akker

Lule

et al. 2019

Tropical Med Int Health

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Objectives To investigate what women who have experienced vacuum extraction or second stage caesarean section (CS) would recommend as mode of birth in case of prolonged second stage of labour. Methods A prospective cohort study was conducted in a tertiary referral hospital in Uganda. Between November 2014 and July 2015, women with a term singleton in vertex presentation who had undergone vacuum extraction or second stage CS were included. The first day and 6 months after birth women were asked what they would recommend to a friend: vacuum extraction or CS and why. Outcome measures were: proportions of women choosing vacuum extraction vs. CS and reasons for choosing this mode of birth. Results The first day after birth, 293/318 (92.1%) women who had undergone vacuum extraction and 176/409 (43.0%) women who had undergone CS recommended vacuum extraction. Of women who had given birth by CS in a previous pregnancy and had vacuum extraction this time, 31/32 (96.9%) recommended vacuum extraction. Six months after birth findings were comparable. Less pain, shorter recovery period, avoiding surgery and the presumed relative safety of vacuum extraction to the mother were the main reasons for preferring vacuum extraction. Main reasons to opt for CS were having experienced CS without problems, CS presumed as being safer for the neonate, CS being the only option the woman was aware of, as well as the concern that vacuum extraction would fail. Conclusions Most women would recommend vacuum extraction over CS in case of prolonged second stage of labour.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 63%

Women's recommendations: vacuum extraction or caesarean section for prolonged second stage of labour, a prospective cohort study in Uganda

Nolens

Akker

Lule

et al. 2019

Tropical Med Int Health

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“…5 Furthermore, caesarean section usually means slower physical and mental maternal recovery and higher health service costs as compared with assisted vaginal birth. [4][5][6] When indications align, such as prolonged second stage of labour or fetal distress during the second stage of labour, use of vacuum extraction can lead to a reduction of unnecessary caesarean sectionsan issue discussed at length in a 2018 Lancet Series 4,5 on caesarean sections.…”

Section: Use Of Assisted Vaginal Birth To Reduce Unnecessary Caesareamentioning

confidence: 99%

“…2,8 In a cohort of 289 women who had vacuum-assisted vaginal birth in this hospital, 257 (91%) were satisfied with their birthing experience. 6 Similarly, a series of interventions (training of staff, monitoring and evaluation, audit, and constructive feedback) were implemented in Mozambique in 2015. These interventions reversed the underutilisation of vacuum extraction, and led to a substantial reduction of maternal mortality and stillbirths.…”

Section: Use Of Assisted Vaginal Birth To Reduce Unnecessary Caesareamentioning

confidence: 99%

Use of assisted vaginal birth to reduce unnecessary caesarean sections and improve maternal and perinatal outcomes

Nolens

Capelle

Roosmalen

et al. 2019

The Lancet Global Health

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“…Mulago National Referral Hospital is a government-run facility with over 2700 beds 14 in Kampala, Uganda. The birth rate has been reported to exceed 39,000 per annum 15 and a substantial proportion of the deliveries are by emergency cesarean section 16 .…”

Section: Introductionmentioning

confidence: 99%

Decision-to-delivery interval of emergency cesarean section in Uganda: a retrospective cohort study

Hughes

Namagembe

Nakimuli

et al. 2019

Preprint

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Background : In many low and medium human development index countries, the rate of maternal and neonatal morbidity and mortality is high. One factor which may influence this is the decision-to-delivery interval of emergency cesarean section. We aimed to investigate the maternal risk factors, indications and decision-to-delivery interval of emergency cesarean section in a large, under-resourced obstetric setting in Uganda. Methods: Records of 344 singleton pregnancies delivered at ≥24 weeks throughout June 2017 at Mulago National Referral Hospital were analysed using Cox proportional hazards models and multivariate logistic regression models. Results : An emergency cesarean section was performed every 104 minutes and the median decision-to-delivery interval was 5.5 hours. Longer interval was associated with preeclampsia and premature rupture of membranes/oligohydramnios. Fetal distress was associated with a shorter interval (p<0.001). There was no association between decision-to-delivery interval and adverse perinatal outcomes (p>0.05). Mothers waited on average 6 hours longer for deliveries between 00:00-08:00 compared to those between 12:00-20:00 (p<0.01). The risk of perinatal death was higher in neonates where the decision to deliver was made between 20:00-02:00 compared to 08:00-12:00 (p<0.01). Conclusion : In this setting, the average decision-to-delivery interval is longer than targets adopted in high development index countries. Decision-to-delivery interval varies diurnally, with decisions and deliveries made at night carrying a higher risk of adverse perinatal outcomes. This suggests a need for targeting the improvement of service provision overnight.

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Birthing experience and quality of life after vacuum delivery and second‐stage caesarean section: a prospective cohort study in Uganda

Abstract: One day and six weeks after birth, outcomes were better in women who had vacuum extraction. At six months, outcomes were similar. To promote quick recovery, vacuum extraction should be the first intervention considered in the second stage of labour.

Cited by 17 publications

References 31 publications

Women's recommendations: vacuum extraction or caesarean section for prolonged second stage of labour, a prospective cohort study in Uganda

Women's recommendations: vacuum extraction or caesarean section for prolonged second stage of labour, a prospective cohort study in Uganda

Use of assisted vaginal birth to reduce unnecessary caesarean sections and improve maternal and perinatal outcomes

Decision-to-delivery interval of emergency cesarean section in Uganda: a retrospective cohort study

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