Browsing by Author "John, Lule"
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- ItemBirthing experience and quality of life after vacuum delivery and second-stage caesarean section: a prospective cohort study in Uganda(Tropical Medicine and International Health, 2018) Barbara, Nolens; Thomas, van den Akker; John, Lule; Sulphine, Twinomuhangi; Roosmalen, Jos van; Josaphat, Byamugishaobjective To assess perceptions of women undergoing vacuum extraction or second-stage caesarean section (SSCS) in a tertiary referral hospital in sub-Saharan Africa. methods Prospective cohort study, with six-month follow-up, of women who gave birth to a term singleton in cephalic presentation by vacuum extraction (n = 289) or SSCS (n = 357) between 25 November 2014, to 8 July 2015, in Mulago Hospital, Uganda. Excluded were women who had failed vacuum extraction, severe birth complications and those whose babies had died. Outcome measures were birthing experience satisfaction, physical component summary (PCS) and mental component summary (MCS) of the SF-12 quality-of-life questionnaire, pain scores and dyspareunia. results One day after vacuum extraction, 63.7% (181/284) of women were feeling well vs. 48.1% (167/347) after SSCS (OR 1.89; 95%CI 1.37–2.61) and mean pain sores were 2.70 vs. 3.87 (P < 0.001). In both groups, >90% of women were satisfied with their birthing experience. At six weeks, in vacuum extraction vs. SSCS, mean pain sores were 0.40 vs. 0.89 (P < 0.001); mean PCS was 48.67 vs. 44.03 (P < 0.001); mean MCS was 52.80 vs. 51.23 (P = 0.203); 40% (70/175) vs. 28.3% (70/247) of women had resumed sexual intercourse (OR 1.69; 95%CI 1.12–2.54) and 21.4% (15/70) vs. 28.6% (20/70) had dyspareunia (OR 0.68; 95%CI 0.32–1.47). No differences were found at six months after birth. conclusion One day and six weeks after birth, outcomes were better in women who had vacuum extraction. At six months, outcomes were similar. To promote quick recovery, vacuum extraction should be the first intervention considered in the second stage of labour.
- ItemProspective cohort study comparing outcomes between vacuum extraction and second-stage cesarean delivery at a Ugandan tertiary referral hospital(John Wiley & Sons Ltd, 2018-04-20) Barbara, Nolens; Flavia, Namiiro; John, Lule; Thomas, van den Akker; Roosmalen, Jos van; Josaphat, ByamugishaObjective: To compare maternal and perinatal outcomes between vacuum extraction and second-stage cesarean delivery (SSCD). Methods: The present observational cohort study was conducted among women with term vertex singleton pregnancies who underwent vacuum extraction or SSCD at Mulago National Referral Hospital, Kampala, Uganda, between November 25, 2014, and July 8, 2015. Severe maternal outcomes (mortality, uterine rupture, hysterectomy, re-laparotomy) and perinatal outcomes (mortality, trauma, low Apgar score, convulsions) were compared between initial delivery mode. Results: Among 13 152 deliveries, 358 women who underwent vacuum extraction and 425 women who underwent SSCD were enrolled in the study. No maternal deaths occurred after vacuum extraction versus five deaths from complications of SSCD. Vacuum extraction was associated with less severe maternal outcomes compared with SSCD (3 [0.8%] vs 18 [4.2%]; adjusted odds ratio [aOR] 0.24, 95% confidence interval [CI] 0.07–0.84). Fetal death during the decision-to-delivery interval was also less common in the vacuum extraction group (3 [0.9%] vs 18 [4.4%]; aOR 0.24, 95% CI 0.07–0.84); however, the perinatal mortality rate did not differ between the vacuum extraction and SSCD groups (29 [8.4%] vs 45 [11.0%], respectively; aOR 0.83, 95% CI 0.49–1.41). One infant in each group exhibited neurodevelopmental anomalies at 6 months. Conclusion: Vacuum extraction had better maternal outcomes and equivalent perinatal outcomes compared with SSCD. These findings encourage re-introduction of vacuum extraction.
- ItemUse of assisted vaginal birth to reduce unnecessary caesarean sections and improve maternal and perinatal outcomes(Elsevier Ltd., 2019) Barbara, Nolens; Capelle, Manuela; Roosmalen, Jos van; Mola, Glen; Josaphat, Byamugisha; John, Lule; Arfang, Faye; Thomas, van den Akker
- ItemWomen’s recommendations: vacuum extraction or caesarean section for prolonged second stage of labour, a prospective cohort study in Uganda(John Wiley & Sons Ltd., 2019) Barbara, Nolens; Thomas, van den Akker; John, Lule; Sulphine, Twinomuhangi; Roosmalen, Jos van; Josaphat, Byamugishaobjectives To investigate what women who have experienced vacuum extraction or second stage caesarean section (CS) would recommend as mode of birth in case of prolonged second stage of labour. methods A prospective cohort study was conducted in a tertiary referral hospital in Uganda. Between November 2014 and July 2015, women with a term singleton in vertex presentation who had undergone vacuum extraction or second stage CS were included. The first day and 6 months after birth women were asked what they would recommend to a friend: vacuum extraction or CS and why. Outcome measures were: proportions of women choosing vacuum extraction vs. CS and reasons for choosing this mode of birth. results The first day after birth, 293/318 (92.1%) women who had undergone vacuum extraction and 176/409 (43.0%) women who had undergone CS recommended vacuum extraction. Of women who had given birth by CS in a previous pregnancy and had vacuum extraction this time, 31/32 (96.9%) recommended vacuum extraction. Six months after birth findings were comparable. Less pain, shorter recovery period, avoiding surgery and the presumed relative safety of vacuum extraction to the mother were the main reasons for preferring vacuum extraction. Main reasons to opt for CS were having experienced CS without problems, CS presumed as being safer for the neonate, CS being the only option the woman was aware of, as well as the concern that vacuum extraction would fail. conclusions Most women would recommend vacuum extraction over CS in case of prolonged second stage of labour.