Abstract
To assess perceptions of women undergoing vacuum extraction or second-stage caesarean section (SSCS) in a tertiary referral hospital in sub-Saharan Africa. 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. 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. 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.
Highlights
IntroductionIncreased use of vacuum extraction or other modes of assisted vaginal birth could potentially prevent many maternal deaths caused by complications of prolonged labour or unsafe caesarean section and a large proportion of stillbirths and neonatal deaths in sub-Saharan Africa [1,2,3,4,5,6,7,8]
The aim of this study was to assess how vacuum extraction was experienced by women after its re-introduction in a tertiary referral hospital in sub-Saharan Africa, using women-centred outcomes such as birthing experience satisfaction; pain one day after birth; and quality of life, pain and dyspareunia six weeks and six months after birth
More women who had given birth by vacuum extraction were nulliparous or had their babies admitted to the neonatology unit, but these findings did not reach statistical significance (Table 1)
Summary
Increased use of vacuum extraction or other modes of assisted vaginal birth could potentially prevent many maternal deaths caused by complications of prolonged labour or unsafe caesarean section and a large proportion of stillbirths and neonatal deaths in sub-Saharan Africa [1,2,3,4,5,6,7,8]. Indications for vacuum extraction are prolonged second stage of labour, foetal distress, maternal exhaustion or the need to avoid expulsive efforts in maternal conditions such as severe anaemia or heart failure [9,10,11,12]. Recent publications suggest that caesarean section in the second stage of labour increases the risk of spontaneous preterm birth in the pregnancy [17, 18]
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