Abstract
Introduction:The overall rate of operative vaginal
delivery is diminishing, but the proportion of operative
vaginal deliveries conducted by vacuum is increasing. As
forceps assisted delivery requires more skill and has more
complications on maternal genital tract, this procedure is
being less frequently practiced. By the 1970s, the vacuum
extractor virtually replaced forceps for assisted deliveries
in most of the countries. Vacuum assisted vaginal delivery
reduces maternal as well as neonatal morbidity and
mortality in prolonged second stage of labor, non reassuring
fetal status and maternal conditions requiring a shortened
second stage.
Materials and Methods: This was a record based
retrospective study of 217 vacuum assisted vaginal
deliveries conducted at Western Regional Hospital,
Pokhara for a period of one year. Patient’s discharge
charts were studied and details of indications for vacuum
application, maternal genital tract status, amount of
blood loss, postpartum hemorrhage (PPH), birth weight,
APGAR score at 1 and 5 minute, Neonatal Intensive Care
Unit (NICU) admission and neonatal death (NND) were
collected. Descriptive data analysis was done using SPSS
program.
Results:Out of the 8778 deliveries conducted during the
study period, 217 (2.47%) cases were vacuum assisted
vaginal deliveries. No significant adverse obstetrics
outcomes were noted. Most frequent indication was fetal
distress which accounted for 53.9%. Though 3rd/4th
degree perineal tears were less, episiotomy rate was higher
(69.1%). Regarding neonatal outcomes, mean APGAR
score at 5 minute was 7.42 ± 1.11 SD and 12.4% neonates
had APGAR score of less than 7 at 5 minute.
Conclusion:When standard criteria for vacuum application
are met and standard norms are followed, there is no
evidence of adverse obstetrics outcomes in vacuum assisted
vaginal delivery. Prompt delivery by a skilled clinician
in non reassuring fetal cardiac status reduces neonatal
morbidity and mortality.
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