Vacuum Delivery in a Tertiary Institution, in Northern Nigeria: A 5-Year Review

I. A. Yakasai^*, I. S. Abubakar, E. M. Yunus

Department of Obstetrics and Gynaecology, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria.

DOI: 10.4236/ojog.2015.54031                

Abstract

Background: There is a progressive shift away from the use of forceps in favour of the vacuum extractor as the instrument of choice for operative vaginal deliveries. The overall objective of this is to improve safe motherhood by reducing the contribution of second stage of labour complications to maternal mortality and morbidity. Objective: This study was carried out to determine the incidence, indications, outcome and complications of Ventouse delivery in Aminu Kano Teaching Hospital, Kano, Nigeria. Materials and Methods: This was a retrospective study carried out at the Aminu Kano Teaching Hospital. The case notes of all parturients who had vacuum deliveries in the hospital within January 2008 to December 2012 were retrieved from the statistics unit of the hospital and analysed using SPSS. Results: 22,680 patients delivered in the hospital over this 5-year period. Ventouse was used on 210 occasions giving an incidence rate of 0.9%. One hundred and eighty (85.7%) had successful vacuum delivery. The failed extractions (14.3%) were delivered by caesarean sections. The mean age of the patients was 29.4 years. The mean parity was 2.2. Ninety (42.9%) were primipara while 120 (57.1%) were multipara. The commonest indication for the vacuum delivery was prolonged second stage of labour in 45.2% of cases. The commonest maternal complication was primary postpartum haemorrhage (9.5%). Foetal complication occurred in about 31% of vacuum deliveries, the commonest (18.1%), being cephalhaematoma. Conclusion: The incidence rate of vacuum delivery is low. Thus, active training in the art of vacuum assisted vaginal delivery is clearly needed during residency.

Keywords

Vacuum, Maternal Complications, Fetal Outcome

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Unzila, A.A. and Errol, R.N. (2009) Vacuum-Assisted Vaginal Delivery. Reviews in Obstetrics & Gynecology, 2, 5-17.
[2]	Baskett, T.F., Fanning, C.A. and Young, D.C. (2008) A Prospective Observational Study of 1000 Vacuum Assisted Deliveries with OmniCup Device. Journal of Obstetrics & Gynaecology, 30, 573-580.
[3]	Clark, S.L., Belfort, M.A. and Hankins, G.D. (2007) Variation in the Rates of Operative Delivery in the United States. American Journal of Obstetrics and Gynecology, 196, 526.e1-526.e5. http://dx.doi.org/10.1016/j.ajog.2007.01.024
[4]	Odoi, A.T. and Opare-Addo, H.S. (2002) Operative Vaginal Delivery, Forceps Delivery and Vacuum Extraction. In: Kwawukume Emuveyan, E.E., Ed., Comprehensive Obstetrics in the Tropics, Asante and Hittscher Printing Press Limited, Accra, 340-351.
[5]	O’Mahony, F., Hofmeyr, G.J. and Menon, V. (2010) Choice of Instruments for Assisted Vaginal Delivery. Cochrane Database of Systematic Reviews, No. 11, Art. No.: CD005455. http://dx.doi.org/10.1002/14651858.CD005455.pub2
[6]	Johnson, R.B. and Menon, V. (1999) Vacuum Extraction versus Forceps for Assisted Vaginal Delivery. Cochrane Database of Systemic Review, No. 2, Art. No.: CD000224.
[7]	Chukwuemeka, A.I. and Hyacinth, E.O. (2006) Vacuum Deliveries at the University of Nigeria Teaching Hospital Enugu. Tropical Journal of Obstetrics and Gynaecology, 23, 23-26.
[8]	Mutihir, J.T. and Pam, V.C. (2007) Vacuum Delivery in Jos University Teaching Hospital, Jos Nigeria. Journal of Medicine in the Tropics, 19, 21-28.
[9]	Abdulkarim, G.M., Othman, K. and Bala, M.A. (2005) Instrumental Vaginal Deliveries at the University of Maiduguri Teaching. Tropical journal of Obststerics and Gynaecology, 22, 42-45.
[10]	Ogedengbe, O.K. and Odeneye, T.O. (2004) Outcome of Instrumental Deliveries in Lagos Nigeria; Implications for Its Use at the Second Tier Healthcare Level. Nigerian Medical Practitioner, 45, 106-110. http://dx.doi.org/10.4314/nmp.v45i6.28714
[11]	Attilakos, G., Sibanda, T., Winter, C., Johnson, N. and Draycott, T. (2005) A Randomised Controlled Trial of a New Handheld Vacuum Extraction Device. BJOG: An International Journal of Obstetrics & Gynaecology, 112, 1510-1515. http://dx.doi.org/10.1111/j.1471-0528.2005.00729.x
[12]	Edozien, L.C. (2007) Towards Safe Practice in Instrumental Vaginal Delivery. Best Practice & Research Clinical Obstetrics & Gynaecology, 21, 639-655. http://dx.doi.org/10.1016/j.bpobgyn.2007.03.006
[13]	Cunningham, F.G., Gant, N.F., Leveno, K.J., Gilstrap, L.C., Hauth, J.C., et al. (2001) Forceps Delivery and Vacuum Extraction. 21st Edition, MacGraw-Hill, USA: Williams Obstetrics, 485-508.
[14]	Dutta, D.C. (1998) Normal Labor. In: Hiralal, K, Ed., Textbook of Obstetrics Including Perinatology and Contraception, 4th Edition, New Central Book Agency Ltd., India, 118-152.
[15]	Beischer, N.A. and Mackay, E.U. (1986) Dystocia. In: Obstetrics and the Newborn, 2nd Edition, Balliere Tindall, London, 443-462.
[16]	Yakasai, A.I., Abubakar, I.S. and Abdullahi, H. (2011) An Audit of Instrumental Vaginal Delivery in Aminu Kano Teaching Hospital, Kano. Tropical Journal of Obstetrics and Gynaecology, 28.
[17]	Kwame-Aryee, R.A. (1999) 2nd Stage of Labor. In: Handbook of Obstetrics, 1st Edition, Max Associates Limited, Ghana, 30-34.
[18]	Johnson, R.B. and Menon, V. (2000) Soft versus Rigid Vacuum Extractor Cups for Assisted Vaginal Delivery. Cochrane Database System Review, No. 2, Art. No.: CD000446. http://dx.doi.org/10.1002/14651858.CD000446
[19]	McQuivey, R.W. (2004) Vacuum-Assisted Delivery: A Review. The Journal of Maternal-Fetal & Neonatal Medicine, 16, 171-180. http://dx.doi.org/10.1080/jmf.16.3.171.180-25
[20]	Gumanga, S.K., Kwame-Aryee, R., Seffah, J.D. and Amuzu, S.K. (2012) Ten-Year Review of Vacuum Assisted Vaginal Deliveries at a District Hospital in Ghana. West African Journal of Medicine, 31, 192-197.
[21]	Prapas, N., Kalogiannidis, I., Masoura, S., Diamanti, E., Makedos, A., Drossou, D. and Makedos, G. (2009) Operative Vaginal Delivery in Singleton Term Pregnancies: Short-Term Maternal and Neonatal Outcomes. Hippokratia, 13, 41-45.
[22]	Bailey, P.E. (2005) The Disappearing Art of Instrumental Delivery: Time to Reverse the Trend. International Journal of Gynecology & Obstetrics, 91, 89-96. http://dx.doi.org/10.1016/j.ijgo.2005.05.016
[23]	Vacca, A. (2006) Reducing the Risk of a Vacuum Delivery. Fetal and Maternal Medicine Review, 17, 301-315. http://dx.doi.org/10.1017/S0965539506001823
[24]	RCOG Green Top a Guidelines No. 29 January 2011 Operative Vaginal Deliveries.
[25]	Baskett, T.F., Fanning, C.A. and Young, D.C. (2008) A Prospective Observational Study of 1000 Vacuum Assisted Vaginal Deliveries with OmniCup Device. Journal of Obstetrics and Gynaecology Canada, 30, 573-580.
[26]	Ijaiya, M.A., Aboyeji, A.P. and Abubakar, D. (2003) Analysis of 348 Consecutive Cases of Primary Postpartum Haemorhage at a Tertiary Hospital in Nigeria. Journal of Obstetrics & Gynaecology, 23, 374-377. http://dx.doi.org/10.1080/0144361031000119529
[27]	Caughey, A.B., Sandberg, P.L., Zlatnik, M.G., Thiet, M.P., Parer, J.T. and Laros, R.K. (2005) Forceps Compared with Vacuum: Rates of Neonatal Maternal Morbidity. Obstetrics & Gynecology, 106, 908-912. http://dx.doi.org/10.1097/01.AOG.0000182616.39503.b2
[28]	Bofill, J.A., Rust, O.A., Schorr, S.J., Brown, R.C., Martin, R.W., Martin Jr., J.N. and Morrison, J.C. (1996) A Randomised Prospective Trial of Obstetric Forceps versus the M-Cup Vacuum Extractor. American Journal of Obstetrics and Gynecology, 175, 1325-1330. http://dx.doi.org/10.1016/S0002-9378(96)70049-2
[29]	Johnson, J.H., Figueroa, R., Garry, D., Elimian, A. and Maulik, D. (2004) Immediate Maternal and Neonatal Effects of Forceps and Vacuum-Assisted Deliveries. Obstetrics & Gynecology, 103, 513-518. http://dx.doi.org/10.1097/01.AOG.0000114985.22844.6d
[30]	Adaji, S.E., Shittu, S.O. and Sule, S.T. (2009) Operative Vaginal Deliveries in Zaria, Nigeria. Annals of African Medicine, 8, 95-99. http://dx.doi.org/10.4103/1596-3519.56236