Declining Rate of Operative Vaginal Deliveries in Nigeria

Anozie, Okechukwu Bonaventure; Lawani, Lucky Osaheni; Onu, Fidelis A.; Onoh, Robinson Chukwudi; Ogah, Emeka Onwe; Eze, Justus N.; Mamah, Johnbosco E.; Asiegbu, Obiora GK; Anozie, Rita O.

doi:10.4236/ojog.2018.83021

Cited by 5 publications

(6 citation statements)

References 26 publications

(16 reference statements)

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“…Addressing the decline in the practice of operative vaginal deliveries including destructive operations as alternatives to caesarean section is relevant to efforts to reduce unnecessary caesarean sections in developing countries. 38,39…”

Section: Discussionmentioning

confidence: 99%

Towards optimizing caesarean section: a five-year review of caesarean sections at a Southern Nigeria hospital

Osegi

Makinde

2019

Int J Reprod Contracept Obstet Gynecol

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Background: Monitoring caesarean sections at hospital level is essential to reduce unnecessary caesarean sections while still ensuring adequate access to caesarean section. This study was conducted to determine the caesarean section rate and indications for caesarean section at the study centre and provide objective data for institutional interventions towards reducing unnecessary caesarean sections in the centre.Methods: A retrospective descriptive study of patients that had caesarean sections between 1st January 2013 and 31st December 2017 at the Federal Medical Centre, Yenagoa, Nigeria. Data were analyzed using Statistical Package for Social Sciences version 22.Results: There were 5,793 deliveries and 1,654 were by caesarean section. The average caesarean section rate was 28.6%. The leading indications for caesarean section were cephalopelvic disproportion (26.6%), previous cesarean section (18.2%), suspected fetal distress (11.2%), severe preeclampsia/eclampsia (7.9%), obstructed labour (6%), and breech presentation (5.9%).Conclusions: The 28.6% caesarean section rate in this study falls within a widely varied rate across Nigeria at hospital level but is comparable to rates within the south-south geopolitical zone of Nigeria. The leading indications for caesarean section are modifiable, thus there is room for institutional intervention to reduce unnecessary caesarean sections. Collaborative research between institutions is required to assess peculiar regional determinants of caesarean section towards developing suitable interventions to reduce unnecessary caesarean sections regionally.

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Section: Discussionmentioning

confidence: 99%

Towards optimizing caesarean section: a five-year review of caesarean sections at a Southern Nigeria hospital

Osegi

Makinde

2019

Int J Reprod Contracept Obstet Gynecol

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“…In recent times, there has been a considerable increase in cesarean section, with rates more 5% 1% 15% In recent times, there has been a considerable n cesarean section, with rates more than 40% whereas the rate of instrumental deliveries is accounting for only 5.3 percent of all births in 2018 [5]. Use of obstetric forceps or vacuum extractor requires that an obstetrician or other obstetric care provider be familiar with the proper use of the instruments and the risks involved [6].…”

Section: Discussionmentioning

confidence: 99%

Assisted Vaginal Delivery - Preference of Vacuum or Forceps among Obstetricians

Gnanasekaran

Kanamma

Dhinakaran

et al. 2021

JPRI

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Objective: To determine the instrument preference among obstetricians practicing operative vaginal deliveries and to determine the prevalence and risks of vacuum or forceps Assisted Vaginal Delivery (AVD). Methods: This cross-sectional study was carried out in ACS Medical and Hospital, Chennai. A total of 520 obstetricians were included in the study. An online questionnaire was sent to all obstetricians in Chennai. The choice of procedure for specific circumstances, instrument preference [use of vacuum or forceps] and views on the complications encountered in both vacuum and forceps use at vaginal delivery were explored. For the replies, we computed means and percentages for the entire group and distinct subgroups. Risk assessment of outcome with exposure as suitable p-value was included in the statistical analysis. Results: Response rate for the questionnaire was 97% (504/520). The findings suggest that obstetricians preference was more towards vacuum due to their ease of usage. Baseline characteristics were similar between the two groups. Failed vacuum due to slipping of the cup was the most common complication faced - 62%, followed by caput succedaneum 25%, both were statistically significant. The most significant finding was that maternal injuries in the vacuum group were only 2% which was way less than those who had forceps delivery (68%) with a p-value of < 0.001. Conclusion: In this research, physician instrument choice is a significant predictor of results that should be taken into account. Use of vacuum for delivery seemed to be the choice of majority of obstetricians [334 (66%)]. Vacuum extractor rather than forceps for assisted delivery appears to reduce maternal morbidity, whereas neonatal injuries were more common in newborns delivered by vacuum. The choice of instrument should be personalized based on the patient's condition and the obstetrician's experience and expertise.

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“…Despite the guidelines, VE is rarely used in many countries around the globe and instead, second‐stage caesarean section is performed. The global rate of assisted vaginal birth in hospitals is 2.6% and continues to decrease 13–16 . In sub‐Saharan Africa, the proportion of institutional births by VE or forceps extraction is even below 1% of all births 17 .…”

Section: Introductionmentioning

confidence: 99%

Vacuum extraction or caesarean section in the second stage of labour: A systematic review

Thierens

Binsbergen

Nolens

et al. 2023

BJOG

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Background: Prolonged second stage of labour is an important cause of maternal and perinatal morbidity and mortality. Vacuum extraction (VE) and second-stage caesarean section (SSCS) are the most commonly performed obstetric interventions, but the procedure chosen varies widely globally. Objectives: To compare maternal and perinatal morbidity, mortality and other adverse outcomes after VE versus SSCS. Search Strategy: A systematic search was conducted in PubMed, Cochrane and EMBASE. Studies were critically appraised using the Newcastle-Ottawa scale. Selection Criteria: All artictles including women in second stage of labour, giving birth by vacuum extraction or cesarean section and registering at least one perinatal or maternal outcome were selected. Data Collection and Analysis:The chi-square test, Fisher exact's test and binary logistic regression were used and various adverse outcome scores were calculated to evaluate maternal and perinatal outcomes. Main Results: Fifteen articles were included, providing the outcomes for a total of 20 051 births by SSCS and 32 823 births by VE. All five maternal deaths resulted from complications of anaesthesia during SSCS. In total, 133 perinatal deaths occurred in all studies combined: 92/20 051 (0.45%) in the SSCS group and 41/32 823 (0.12%) in the VE group. In studies with more than one perinatal death, both conducted in low-resource settings, more perinatal deaths occurred during the decision-to-birth interval in the SSCS group than in the VE group (5.5% vs 1.4%, OR 4.00, 95% CI 1.17-13.70; 11% vs 8.4%, OR 1.39, 95% CI 0.85-2.26). All other adverse maternal and perinatal outcomes showed no statistically significant differences. Conclusions: Vacuum extraction should be the recommended mode of birth, both in high-income countries and in low-and middle-income countries, to prevent unnecessary SSCS and to reduce perinatal and maternal deaths when safe anaesthesia and surgery is not immediately available.

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Declining Rate of Operative Vaginal Deliveries in Nigeria

Cited by 5 publications

References 26 publications

Towards optimizing caesarean section: a five-year review of caesarean sections at a Southern Nigeria hospital

Towards optimizing caesarean section: a five-year review of caesarean sections at a Southern Nigeria hospital

Assisted Vaginal Delivery - Preference of Vacuum or Forceps among Obstetricians

Vacuum extraction or caesarean section in the second stage of labour: A systematic review

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