Outcome of Instrumental Deliveries in Lagos Nigeria Implications For its Use at the Second Tier Healthcare Level

Abstract

The case notes of patients undergoing instrumental delivery at the Lagos University Teaching Hospital between 1st January 1994 and 31st December 1996 were analysed. The overall instrumental delivery rate was 4.9% with an overall forceps delivery rate of 1.8% and vacuum extraction rate of 2.9%. Vacuum extraction was used in 59.4% of cases and forceps in 36.3% to assist vaginal delivery.


Patients aged 20-29years accounted for 57% and nulliparous patients 67% of those


Undergoing instrumental delivery. In 47.7% of cases the procedure was elective. The commonest indication being pre-eclampsia and eclampsia (25.4%). Prolonged second stage in 28.4% of cases was the commonest indication for emergency delivery.


Maternal complications were twice as common in patients undergoing forceps delivery (26.9%) as opposed to vacuum extraction (13.8%). Neonatal complications were more common following forceps delivery (37.9%) compared to vacuum extraction (13.4%) There were four neonatal deaths all following forceps delivery.


Vacuum extraction appears to be a safer method of instrumental delivery than the obstetric forceps. Maternal and perinatal morbidity and mortality may benefit from the training of midwives and non-specialist doctors in the procedure of vacuum extraction in an emergency at the secondary health care level.


Key Words: Instrumental delivery, secondary health care, Lagos Nigeria.


Nigerian Medical Practitioner Vol. 45 No 6, 2004 (106-110)