VACUUM EXTRACTION AND FORCEPS DELIVERIES;

COMPARISON OF MATERNAL AND NEONATAL MORBIDITY

Abstract

Objective: To compare the maternal and neonatal morbidity between vacuum extraction versus forceps vaginal delivery. Study
design: Quasi-experimental study. Period: January 2009 to December 2010. Setting: Department of Obstetrics and Gynecology CMC,
SMBBMU Larkana. Methodology: 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. Results: 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). Conclusions: 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.