A comparative study of feto-maternal outcome in instrumental vaginal delivery

Long-term neurodevelopmental outcome in children born after vacuum-assisted delivery compared with second-stage caesarean delivery and spontaneous vaginal delivery: a cohort study

OBJECTIVE

To evaluate long-term neurodevelopment in children born after low-or mid-station vacuum-assisted delivery (VAD) compared with children delivered by second-stage caesarean delivery (SSCD) or spontaneous vaginal delivery (SVD).

DESIGN

Cross-sectional cohort study.

SETTING

Two delivery wards, Karolinska University Hospital, Sweden.

PATIENTS

253 children born by low-station or mid-station VAD, 247 children born after an SVD, and 86 children born via an SSCD accepted to participate.

INTERVENTIONS

The Five-to-Fifteen questionnaire was used as a validated screening method for neurodevelopmental difficulties, assessed by parents.

MAIN OUTCOMES MEASURES

Results in the Five-to-Fifteen questionnaire. In addition, registered neurodevelopmental ICD-10 diagnoses were collected. Regression analyses estimated associations between delivery modes.

RESULTS

Children born after VAD exhibited an increased rate of long-term neurodevelopmental difficulties in motor skills (OR 2.2, 95% CI 1.3 to 3.8) and perception (OR 1.7, 95% CI 1.002 to 2.9) compared with SVD. Similar findings were seen in the group delivered with an SSCD compared with SVD (motor skills: OR 3.3, 95% CI 1.8 to 6.4 and perception: OR 2.3, 95% CI 1.2 to 4.4). The increased odds for motor skills difficulties after VAD and SSCD remained after adjusting for proposed confounding variables. There were significantly more children in the VAD group with registered neurodevelopmental ICD-10 diagnoses such as attention deficit/hyperactivity disorders.

CONCLUSIONS

The differences in long-term neurodevelopmental difficulties in children delivered with a VAD or SSCD compared with SVD in this study indicate the need for increased knowledge in the field to optimise the management of second stage of labour.

Prevalence and associated factors of perinatal asphyxia in newborns admitted to neonatal intensive care unit at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, Ethiopia

Background

Perinatal asphyxia is one of the leading causes of neonatal mortality and morbidity in Ethiopia. Understanding associated factors of perinatal asphyxia are important to identify vulnerable groups and to improve care during the perinatal period. Thus, this study aimed to assess the prevalence and associated factors of perinatal asphyxia among newborns admitted to NICU at the Gondar University Comprehensive Specialized Hospital Northwest Ethiopia, Ethiopia.

Method

Institutional based cross-sectional study was conducted on 364 newborns from November 2018 - August 2019. Data was collected using a structured and pre-tested questionnaire. It was then cleaned, coded, and entered using EPI INFO version 7, then analyzed with SPSS statistics version 20.0. Binary logistic regression analysis was used to identify variables with p < 0.2. An adjusted odds ratio (AOR) with a 95% CI and P-value of <0.05 was used to identify significantly associated variables with perinatal asphyxia.

Result

The prevalence of perinatal asphyxia in this study was 19.8, 95%CI (15.9, 24.2). Absence of maternal formal education (AOR = 4.09, 95%CI: 1.25, 13.38), pregnancy-induced hypertension (AOR = 4.07, 95%CI: 1.76, 9.40), antepartum hemorrhage (AOR = 6.35, 95%CI: 1.68, 23.97), prolonged duration of labor (AOR = 3.69, 95%CI: 1.68, 8.10), instrumental delivery (AOR = 3.17, 95%CI: 1.22, 8.21), and meconium-stained amniotic fluid (AOR = 4.50, 95%CI: 2.19, 9.26) were significantly associated with perinatal asphyxia.

Conclusion

The prevalence rate of perinatal asphyxia in this study was comparable to other resource poor countries. The absence of maternal formal education, pregnancy-induced hypertension, and Antepartum hemorrhage, prolonged duration of labor, Instrumental assisted delivery, and meconium-stained amniotic fluid was having significant association with perinatal asphyxia in this study.

Birth-Related Perineal Trauma in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis

Introduction Birth-related perineal trauma (BPT) is a common consequence of vaginal births. When poorly managed, BPT can result in increased morbidity and mortality due to infections, haemorrhage, and incontinence. This review aims to collect data on rates of BPT in low- and middle-income countries (LMICs), through a systematic review and meta-analysis. Methods The following databases were searched: Medline, Embase, Latin American and Caribbean Health Sciences Literature (LILACs), and the World Health Organization (WHO) regional databases, from 2004 to 2016. Cross-sectional data on the proportion of vaginal births that resulted in episiotomy, second degree tears or obstetric anal sphincter injuries (OASI) were extracted from studies carried out in LMICs by two independent reviewers. Estimates were meta-analysed using a random effects model; results were presented by type of BPT, parity, and mode of birth. Results Of the 1182 citations reviewed, 74 studies providing data on 334,054 births in 41 countries were included. Five studies reported outcomes of births in the community. In LMICs, the overall rates of BPT were 46% (95% CI 36–55%), 24% (95% CI 17–32%), and 1.4% (95% CI 1.2–1.7%) for episiotomies, second degree tears, and OASI, respectively. Studies were highly heterogeneous with respect to study design and population. The overall reporting quality was inadequate. Discussion Compared to high-income settings, episiotomy rates are high in LMIC medical facilities. There is an urgent need to improve reporting of BPT in LMICs particularly with regards to births taking in community settings.

Maternal complication related to instrumental delivery at Felege Hiwot Specialized Hospital, Northwest Ethiopia: a retrospective cross-sectional study

OBJECTIVE

The study aimed to determine proportion and risk factors for maternal complication related to forceps and vacuum delivery among mother who gave birth at Felege Hiwot Comprehensive Specialized Hospital (FHCSH).

RESULTS

Records of 406 mothers managed with instrumental vaginal delivery were reviewed and 97% of the reviewed card had complete documentation. The proportion of maternal complications related to instrumental delivery was 12.1%. A major complication of forceps assisted delivery was 2nd-degree perineal tear (7.4%), 3rd-degree perineal tear (1.5%), cervical tear (1.5%) and episiotomy extension (1%). However, the complication of vacuum-assisted vaginal delivery was only cervical tear (0.5%) and episiotomy extension (0.5%). Episiotomy during instrumental delivery reduce maternal complication by 86% [AOR = 0.14, 95% CI 0.07-0.3]. Forceps assisted vaginal delivery had 3.4 times more risk for maternal complication compared to vacuum-assisted vaginal delivery [AOR = 3.4, 95% CI 1.08-10.67] and the same is true for primiparity that primipara women who gave birth by the help of instrument had 3.5 times more risk for maternal complication compared to a multipara women [AOR = 3.5, 95% CI 1.26-9.98].

Prevalence and Outcome of Operative Vaginal Delivery among Mothers Who Gave Birth at Jimma University Medical Center, Southwest Ethiopia

Background

Operative vaginal deliveries (OVD) are vaginal deliveries accomplished with the use of a vacuum device or forceps. If it is technically feasible and can be safely accomplished, termination of second stage labor by operative vaginal delivery is indicated in any condition threatening the mother or fetus that is likely to be relieved by delivery. Hence, the objective of this study is to assess the prevalence, common indication, outcome, and associated factors of operative vaginal delivery among mothers who gave birth in Jimma University Medical Center (JUMC).

Method

A facility-based cross-sectional study design was used in maternity ward on 242 mothers who gave birth by operative vaginal delivery from December 01, 2016, to May 30, 2017. The clinical data were collected using a check list, recordings of intrapartum fetal and maternal state, and immediate fetomaternal outcomes. The study participants were recruited using consecutive sampling method. Sociodemographics and related data were collected at exit using structured interviewer administered questionnaire which was developed by reviewing different literature and the remaining information abstracted from patient charts. Data were entered to Epidata 3.1 and exported to SPSS version 21 for analysis. Bivariate analysis was done to identify candidate variables using p<0.25. Multivariable logistic regression was used to control the effect of confounding variables and to identify factors affecting the fetomaternal outcome. Statistical significance was declared at P<0.05 using adjusted OR with 95% CI.

Result

Out of the 2348 pregnant mothers who gave birth in the labor ward of JUMC during the 6 months of the study period, 242 (10.3%) were by operative vaginal delivery (OVD). The commonest indication for operative vaginal delivery is found to be nonreassuring fetal heart rate pattern, 136 (56.2%). Out of all neonates delivered by operative vaginal delivery 210 (86.8%) had favorable outcome. Of all mothers who gave birth by operative vaginal delivery 232 (95.9%) had favorable outcome. Type of instrument used for operative vaginal delivery (AOR=0.228, 95%CI: 0.078, 0.671) and presence of grade two (AOR=0.163, 95%CI: 0.031, 0.858) and grade three (AOR=0.088,95%CI: 0.024,0.327) meconium stained amniotic fluid are factors affecting neonatal outcome while neonatal birth weight (AOR=0.007, 95%CI: 0.000, 0.151) is factor affecting maternal outcome of operative vaginal delivery.

Conclusion

Prevalence of operative vaginal delivery is found to be 10.3% with the commonest indication of nonreassuring fetal heart rate pattern. Nearly all of mothers and neonates had favorable outcome. Type of instrument applied for operative vaginal delivery is the strongest predictor of neonatal outcome while neonatal birth weight is the only predictor of maternal outcome identified in this study.

Outcome of forceps delivery in a teaching hospital: A 2 year experience

Introduction:

The art of forceps delivery though existing for centuries has earned a disreputation due to the possibility of poor maternal and fetal outcome. However, its safe use can reduce the rising cesarean section rates in the present times. This study is to see the outcome of its use in a teaching hospital over a 2 year period.

Materials and Methods:

In this retrospective observational study, 120 cases of forceps delivery were studied for maternal outcome such as injuries, postpartum hemorrhage, and fetal outcome such as Apgar score at birth, neonatal intensive care unit admissions, injury, and mortality.

Results:

The most common indication was fetal distress (47.5%). A total of 15 cases (12.5%) of maternal injuries occurred, with 2 uterine ruptures one of which was in a previous lower segment caesarean section case, 4 complete perineal tears and 9 minor cervical and vaginal lacerations. A total of 12 babies (10%) had poor Apgar scores who recovered after resuscitation and one out of them died, which was a case of multiple instrumentation.

Conclusion:

Forceps is a reasonable option for the obstetrician to reduce the caesarean section rates; however, extreme caution, proper expertise and judicial use of this instrument are required to prevent undue risk to mother and fetus.