Instrumental Vaginal Delivery at Jos University Teaching Hospital (Juth): Forceps Versus Vacuum Extraction, a Four Year Retrospective Review

Abstract

Abstract Background: Instrumental vaginal delivery, either with forceps or vacuum-assisted, is used to facilitate childbirth and to avoid caesarean section delivery (CS) and its associated morbidities. Nevertheless, instrumental techniques are associated with a greater tendency for birth injury than spontaneous delivery. There is a need to maintain and improve the skills for this procedure through training and research in order to improve the benefits for both mothers and their babies. Objectives: 1. To determine and compare the incidence of vacuum versus forceps. 2. Indications of instrumental vaginal delivery. 3. Compare the foetal and maternal outcome of vacuum and forceps deliveries. Materials and Methods: This was a retrospective review on instrumental vaginal deliveries (vacuum extraction and forceps delivery) carried out between 1st January 2011 and 31st December 2014. The hospital records of all the patients who had vacuum or forceps delivery were obtained and data on age, parity, booking status, and type of procedure performed, APGAR scores of babies delivered and complications were entered into a proforma and analyzed using SPSS software for Windows version 16.0. Results: During this study period, there were 7,503 deliveries out of which 42 (0.56%) were instrumental deliveries. The rates were 0.53% and 0.03% for vacuum and forceps deliveries respectively. Unbooked patients were 6 (14.3%) while 36 (85.7%) were booked. The commonest indication was material exhaustion (35.6%). Mean birth weight of babies were 3091.84g. The perinatal outcome showed that 77.5% had Apgar scores of 7 and above at one minute. This was increased to 87.5% at the 5th min. the mean blood loss was 310mls. Thirty of the mothers were free of complications. The commonest complication was perineal tear ac-counting for 11.9%. Conclusion: The rate of instrumental vaginal deliveries in this institution is low and indications for the procedure are similar to those found elsewhere. It is also evident from this studies that forceps delivery is a dying saving art as compared to vacuum delivery, therefore, obstetricians should be trained properly so as to optimize their benefit. There is significant difference in terms of foetal and maternal outcomes between those who had forceps delivery and those who had vacuum delivery.