Prospective cohort study comparing outcomes between vacuum extraction and second-stage cesarean delivery at a Ugandan tertiary referral hospital
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Date
2018-04-20
Journal Title
Journal ISSN
Volume Title
Publisher
John Wiley & Sons Ltd
Abstract
Objective: 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.
Description
Keywords
Cesarean delivery; Instrumental delivery; Maternal morbidity; Maternal mortality; Neonatal morbidity; Perinatal mortality; Vacuum extraction; Ventouse delivery