Vacuum Assisted Vaginal Delivery in Singleton Term Pregnancies: Short Term Maternal and Neonatal Outcome in a Tertiary Hospital of Nepal

Abstract

Introduction: Other than cesarean delivery, assisted vaginal delivery is an alternative procedure for delivery in emergency obstetrics. Presently, vacuum delivery has gained more popularity than forceps for operative/ assisted vaginal delivery, when and where indicated, with success as well as lesser neonatal and maternal complications. This study was done to estimate the short term maternal and fetal morbidity/mortality due to vacuum assisted vaginal delivery.
 
 Methods: A prospective observational study was conducted at Lumbini Medical College Teaching Hospital from January 2015 to May 2016. One hundred and four pregnant women who had successful vacuum assisted vaginal deliveries were enrolled. Fetal and maternal outcome were assessed.
 
 Results: One hundred and four successful vacuum deliveries (2.9%) were conducted among 3457 deliveries during our study period. Sixty seven (64.4%) were primigravida and most (n=59, 56.7%) parturients were of age group 20-30 years. The commonest (n=65, 62.5%) indication for vacuum application was prolonged second stage of labor. The maternal morbidity variables were: 6.7% (n=7) had genital tract injury, 3.8% (n=4) had primary post-partum hemorrhage, 3.8% (n=4) had urinary retention, 2.8% (n=3) needed blood transfusion. Among neonatal morbidity indicators, 19.2% (n=20) neonates had birth asphyxia, 4.8% (n=5) neonates had cephalohematoma, 0.96% (n=1) had brachial plexus injury. There was one early neonatal death due to meconium aspiration syndrome.
 
 Conclusion: A successful vacuum assisted delivery can be achieved with lesser maternal and neonatal morbidity with timely assessment of labor, skilled operator, and availability of neonatal team.

Cesarean Section or Instrumental Delivery: The Best Choice for Mode of Delivery during Second Stage of Labor

“…Contradicting the current study, Shrestha BK et al stated that prolonged second stage of labor followed by fetal distress (19.2%), poor maternal effort (9.6%) and to shorten the second stage of labour (8.6%) respectively, were the commonest indications for application of instruments. 25 Non descent of head in second stage of labour contributed to the largest number (77.1%) undergoing CS, similar to the study done by Babre VM et al where non-descent of the head was the second most common indication leading to CS. Non descent of head in both these studies can be credited to CPD or to DTA.…”

Maternal Complications Related to Operative Vaginal Delivery and Their Associated Factors among Women Delivered at NEMCS Hospital, Southwest Ethiopia

“…Tis study revealed a postpartum hemorrhage rate of 6.4%. Tis fnding was consistent with the study conducted in Jimma Medical Centre (3.3%), tertiary hospital of Mumbai, India (4.01%), Lumbini Teaching Hospital of Nepal (3.8%), and Amino Kano Hospital, Nigeria (9.5%) [14,[17][18][19]. However, this study's result of postpartum hemorrhage rate was lower than that of the University Hospital of Port, Nigeria (42.3%) [20].…”

Maternal and neonatal outcomes in vacuum assisted births in the government tertiary care hospital in Mandya: a retrospective record-based study

“…There was one (0.96%) early neonatal death due to meconium aspiration syndrome. 20 Jason B et al in USA found that maternal morbidity among nulliparous women who underwent vacuum assisted delivery was 31%, third and fourth degree perineal tear was 16%, infections were 10%, lacerations were 5%, hemorrhage was 5% and < 1% had to stay in the hospital for more than 5 days. 19 Neonatal morbidity for vacuum assisted vaginal births in California between 2008 to 2012 was 13.3%.…”

“…These findings are in line with the study done by Chaudhari et al, Jason B et al, and Shresta et al except the neonatal morbidity rate which is less in our study, compared to few studies as even the experience, techniques of vacuum application and facilities at the intra-natal period make an impact in prevention of the complications. 8,[18][19][20] Chaudari P et al, in Uttarakhand found that in vacuum assisted deliveries 68% women needed episiotomy, 9% had perinial tear, 3% had vaginal / periurethral tear, 1% had post partumhemorrage and 1% needed blood transfusion. Morbidities of the newborns were 13% had NICU admissions, 18% neonates had cephalhematoma, 13% had hyperbilirubinemia, 11% had bruising, 5% had convulsions, 5% had feeding difficulties and 1% had irritability.…”