Vacuum extraction and forceps deliveries; comparison of maternal and neonatal morbidity

ABSTRACT

To compare the maternal and neonatal morbidity between vacuum extraction versus forceps vaginal delivery. Quasi-experimental study. January 2009 to December 2010. Setting: Department of Obstetrics and Gynecology CMC, SMBBMU Larkana. All patients delivered by forceps or vacuum with singleton pregnancy were included, the patient with multiple gestation, breech presentation and gestational age less than 34 weeks were excluded. Data collected in pre-set Proforma include type of instrument used, indication of instrumental delivery, maternal and neonatal complications of procedure. Data was analyzed; frequency and percentage will be calculated for maternal age, gestational age, and degree of perineal and cervical tears. .chi-square test was applied to compare the degree of neonatal and maternal complications. P-value less than 0.05 taken as significant. Total 9, 5600 deliveries were conducted, among them assisted vaginal deliveries were169 making the frequency of 2.66%, among which 96 have forceps and 64 were ventouse vaginal deliveries. Majority of women were primigravida. In infants of less than 37 weeks of gestation the use of forceps was significantly more common, delay in second stage of labor was the most common indication for vacuum extraction while fetal distress was more common reason for forceps delivery. Severe birth canal injuries [third and fourth degree perineal tears] and procedure related blood loss of more than 500 ml was significantly more common in forceps delivery group. Cephalhaematoma, neonatal jaundice and severe caput succedanum at discharge were more seen in vacuum deliveries, but facial injuries were more common after forceps delivery. Intracranial hemorrhage was identified in two infants born by vacuum extraction and none in forceps group. Two infants delivered by vacuum extraction expired, one due to respiratory distress and other due to intracranial hemorrhage, and one of the infants delivered by forceps expired due to meconium aspiration syndrome [MAS]. Each instrument has its own merits and demerits .Maternal and neonatal outcome depends on indications of instruments, patient selection and skill of operator. We conclude that forceps delivery is more associated with maternal genital tract trauma and vacuum delivery is associated with more neonatal complications. So it is the choice of obstetrician to select the proper instruments. We also suggest that obstetricians learn these skills not on patients but in a skill laboratory using models