Instrumental vaginal delivery - an assessment of use in a tertiary care centre

Abstract

Background: Majority of women in sub-Saharan Africa expect to achieve  spontaneous vaginal delivery at the end of pregnancy. This is usually possible, but, a few women will receive one form of assistance or another (forceps or vacuum) to avert maternal or foetal morbidity or mortality. Training and research in instrumental vaginal delivery will improve the benefit for mothers and their babies and also, maintain and improve the skills for these procedures.
Objectives: To determine the incidence, indications, cadre of birth attendant and outcome of instrumental vaginal delivery in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
Methodology: This was a 5-year retrospective study. Records of patients, who had vacuum or forceps delivery from 1st January, 2008 to 31st December, 2012 were retrieved and relevant data extracted and analyzed using the SPSS for windows version 20.0.
Results: The incidence of instrumental vaginal delivery was 1.06% of all deliveries (0.08% for forceps and 0.98% for vacuum). Vacuum-assisted delivery accounted for 92.1%. Forceps-assisted delivery showed a decline over the years while vacuum use remained constantly higher. Delayed second stage of labour (68.6%) and eclampsia (24.8%) were the common indications. Resident trainees (93.4%) applied the instruments and the most common maternal complication was post-partum haemorrhage (11.1%) followed by perineal laceration (5.9%). Few neonates (4.6%)suffered complications.
Conclusion: The incidence of instrumental vaginal delivery is low. There is an obvious shift from the use of forceps to vacuum-assisted delivery and this may explain the good maternal and perinatal outcomes.

Keywords: Forceps, vacuum, training, residents, outcome, Sokoto