Rate Of Instrumental Vaginal Delivery Research Articles

Status of the midwifery workforce and childbirth services and the impact of midwife staffing on birth outcomes in China: a multicentre cross-sectional study

ObjectiveTo investigate the status of the midwifery workforce and childbirth services in China and to identify the association between midwife staffing and childbirth outcomes.DesignA descriptive, multicentre cross-sectional survey.SettingMaternity hospitals from...

Predictors of adverse perinatal and maternal outcomes of instrumental vaginal delivery at a tertiary setting in Ethiopia: A cross‐sectional study

AbstractObjectiveTo determine the rate of instrumental vaginal delivery (IVD) and the predictors of adverse maternal and fetal outcomes associated with it in an Ethiopian setting.MethodsA cross‐sectional study was conducted from October 1, 2018, to January 31, 2019, at St. Paul's Hospital Millennium Medical College (SPHMMC) (Addis Ababa, Ethiopia). Data on obstetric characteristics, perinatal and maternal outcomes of women who delivered through IVD were collected prospectively, using a structured questionnaire. Data were analyzed using SPSS version 22 and descriptive analysis was applied to analyze baseline characteristics. Multivariable logistic regression model was fitted to predict the association between short‐term complications of IVD and their determinants. Odds ratio, 95% CI, and p‐value < 0.05 were used to present significance of study findings.ResultsThere were 3165 deliveries during the study period, out of which 241 (7.6%) were instrumental vaginal deliveries. Sequential use of instrumental delivery (AOR = 4.82 [95% CI = 2.10–27.29] and AOR = 6.43 [95% CI = 1.19–34.73], for maternal and fetal complications, respectively) was associated with increased both maternal and fetal complications. Three number of pulls during the extraction was associated with increased fetal complications (AOR = 1.19 [95% CI = 1.05–1.67]).ConclusionThe rate of instrumental delivery rate in our setting is high with sequential use of instrumental delivery found to be associated with increased adverse maternal and fetal outcomes while three number of pulls were associated with increased fetal adverse outcomes.

Results of the 2021 French National Perinatal Survey and trends in perinatal health in metropolitan France since 1995

To report results of the 2021 French National Perinatal Survey (ENP) in metropolitan France and assess trends in the main indicators of perinatal health, medical practices, and risk factors in France since 1995. All the samples included all women giving birth at a gestational age of at least 22 weeks of gestation and/or to an infant weighing at least 500 grams in all maternity units in metropolitan France during one week in 1995 (N=13048), 2003 (N=14324), 2010 (N=14546), 2016 (N=12553), and 2021 (N=12088). The data came from postpartum interviews of the women at the hospital and their medical records. Comparisons between surveys showed trends over time. Between 1995 and 2021, maternal characteristics changed. Maternal age and the frequency of women with obesity rose: in 2021, 24.6% of women were 35 years or older (21.1% in 2016, 19.2% in 2010, 15.9% in 2003 and 12.4% in 1995) and 14.4% were obese (11.8% in 2016, 9.9% in 2010 and 7.4% in 2003). Some antenatal prevention behaviors that improved in 2021 were not smoking during the third trimester, acid folic administration before pregnancy, and vaccination against influenza. The percentage of women with an early prenatal appointment ("4th month appointment"), implemented to facilitate screening of maternal vulnerability during pregnancy, has continued to rise. The percentage of women receiving prenatal care by midwives has risen markedly (39.0% in 2021 versus 11.7% in 2016). Serum screening for Down syndrome continues to increase (91.8% of women in 2021). The rate of induction of labor has risen significantly (20.2% in 1995 and 25.8% in 2021). The mode of delivery has not varied significantly since 2003; in 2021, the cesarean rate was 21.4% and the instrumental vaginal delivery rate 12.4%. Episiotomy was increasingly rare, among both primiparous and multiparous women (16.5% and 2.9% in 2021, respectively). The prevalence of coronavirus (SARS-CoV2) infection during pregnancy was 5.7%. Preterm live births increased regularly, slightly but significantly over the 1995-2016 period and then remained stable between 2016 and 2021 (7.0%). In 2021, 56.3% of women exclusively breastfed during their hospital stay, a modest increase in comparison with 2016 (54.6%). Routine national perinatal surveys highlight positive trends over time in some preventive practices, decreases in some medical interventions consistent with national guidelines, and the increasing role of midwives in prenatal care. Nonetheless, some indicators remain less than optimal and require more detailed analyses.

Pain management during labor: use of intermittent drug delivery devices for improvement of obstetric and neonatal outcome and reduction of healthcare burden: A large non-inferiority randomized clinical trial

BackgroundAutomated continuous epidural administration of local anesthetics provides a more stable analgesic block with decreasing of healthcare staff compared to manual boluses administration (TOP-UP) but is associated to high rate of operative vaginal delivery. We hypothesized that the use of programmed intermittent automated boluses (PIEB) is able to provide a good quality of analgesia and decreasing of anesthesiologic workload without increasing the rate of instrumental vaginal birth in comparison with TOP-UP technique. Laboring nulliparous woman aged between 18 and 46 years were randomized to epidural analgesia with 0.0625% levobupivacaine and sufentanil administered by PIEB or by TOP-UP techniques. Primary outcome was instrumental vaginal delivery rate and secondary outcomes were quality of analgesia, total and time-related drugs doses used, motor block, newborn outcome, and anesthesiologic workload.ResultsSix hundred twenty-nine were randomized, and 628 were included in the intention-to-treat analysis. The rate of instrumental vaginal delivery was similar in the PIEB and TOP-UP groups (13.2% vs 9.7%, OR 1.4 95% CI 0.8 to 2.5; p 0.21). There was no difference between groups regarding mode of delivery (cesarean section vs vaginal birth), newborn outcome, and motor block. Patients in the PIEB group received more total and time-related drugs doses and a better quality of analgesia. Anesthesiological workload was significantly reduced in the PIEB group.ConclusionsOur study demonstrated that epidural anesthesia with programmed intermittent epidural boluses by an automated device provides an effective and safe management of labor analgesia with improvement of pain control and sparing of man workload compared to manual top-up protocols.

Cervical Dilation at the Time of Epidural Catheter Insertion Is Not Associated With the Degree of Prolongation of the First or Second Stages of Labor, or the Rate of Instrumental Vaginal Delivery

(Acta Obstet Gynecol Scand. 2020;99:1039–1049) Although epidural analgesia (EA) is used in over 60% of deliveries in Western countries with high patient satisfaction, it has been associated with risk of prolonged second stage of labor and instrumental vaginal delivery. The optimal time to administer EA based on cervical dilation is unknown, and whether the timing of its administration affects the duration of the first and second stages of labor or maternal or fetal outcomes. The aim of this study was to determine if the cervical dilation at the time of epidural placement impacts the duration of the first and/or second stage of labor and correlates with the rate of instrumental vaginal delivery.

Effect of Oral Carbohydrate Intake During Labor on the Rate of Instrumental Vaginal Delivery: A Multicenter, Randomized Controlled Trial

(Anesth Analg. 2020;30:1670–1677) Mendelson’s description of gastric fluid inhalation led to the practice of starving pregnant women during labor. Contrary to this practice, however, fluid consumption during labor has been shown to be safe and feasible. No definitive evidence exists to support food and fluid restriction during low-risk labors, unless a cesarean delivery (CD) becomes likely. In fact, the food and fluid restriction has been shown to create a shift toward the anaerobic pathway of glucose metabolism, despite a high glycogen content and turnover in the myometrium, thereby suggesting a relative energy shortage. This shortage may explain a commonly observed production of ketone bodies during labor, which results from fat metabolism following glycogen storage depletion. Ketosis during labor can be prevented by either allowing women in labor a light diet, or by allowing caloric intake via isotonic sports drinks. Ketosis and exhaustion can lead to a need for instrumental vaginal delivery when fatigue or inadequate progress develop during labor. The authors of this study hypothesized that carbohydrate intake, such as consuming isotonic sports drinks during labor, could reduce the instrumental vaginal delivery rate.

Effects of upright positions during the second stage of labour for women without epidural analgesia: A meta-analysis.

To assess the effects of upright positions on maternal outcomes for women without epidural analgesia in comparison with recumbent positions during the second stage of labour. Upright positions have many physiological advantages. The underlying benefits and risks of upright positions during the second stage of labour have been reported in many studies but the results are divergent. A meta-analysis of randomized controlled trials. The Cochrane Library, PubMed, Embase, CINAHL and ProQuest databases were systematically searched from inception to 17 June 2019. We conducted the quality appraisal using the Cochrane Collaboration's tool and performed meta-analyses using the Review Manager 5.3 software. The primary outcomes were instrumental vaginal delivery and the duration of the second stage of labour. Overall, 12 studies including 4,314 women were included. Upright positions significantly decreased the rate of instrumental vaginal delivery (risk ratio [RR]=0.74, 95% CI 0.59-0.93), shortened the active pushing phase (mean difference [MD]=-8.16min, 95% CI -16.29 to -0.02), decreased the rate of severe perineal trauma (RR=0.35, 95% CI 0.14-0.87) and episiotomy (RR=0.52, 95% CI 0.29-0.92), but significantly increased the rate of second-degree perineal trauma (RR=1.45, 95% CI 1.10-1.90). However, there was no significant difference in the duration of the second stage of labour or postpartum haemorrhage. Upright positions are beneficial for improving maternal outcomes. Several results should be considered with caution. Researchers need to clarify the definition of upright positions and conduct large, robust studies in the future to provide stronger evidence. This meta-analysis explores a crucial issue in intrapartum care and clarifies the benefits and possible risks of upright positions in the second stage of labour. Midwives and obstetricians are encouraged to apply upright positions depending on women's preferences and labour progress but should take measures to prevent perineal trauma.

Does Programmed Intermittent Epidural Bolus Improve Childbirth Conditions of Nulliparous Women Compared With Patient-controlled Epidural Analgesia? A Multicentre, Randomized, Controlled, Triple-blind Study

(Eur J Anaesthesiol. 2019;36:755–762) Currently about 80% of deliveries in France involve an epidural for labor analgesia. Epidural rates and programs have changed over time, but various authors have found that a programmed intermittent epidural bolus (PIEB) plus patient-controlled epidural analgesia (PCEA) demand dosing strategy for maintenance of labor analgesia decreased the rate of instrumental vaginal delivery, lessened anesthetic drug consumption and increased maternal satisfaction scores compared with a continuous background infusion+PCEA. This study aimed to investigate whether the use of a modern PIEB pump improved the mechanics of the second stage of labor compared with a conventional epidural analgesia technique.

Effect of Oral Carbohydrate Intake During Labor on the Rate of Instrumental Vaginal Delivery: A Multicenter, Randomized Controlled Trial.

Carbohydrate intake during physical exercise improves muscle performance and decreases fatigue. We hypothesized that carbohydrate intake during labor, which is a period of significant physical activity, can decrease the instrumental vaginal delivery rate. In a multicenter, prospective, randomized, controlled trial, healthy adult pregnant women presenting with spontaneous labor were assigned to a "Carbohydrate" group (advised to drink 200 mL of apple or grape juice without pulp every 3 hours) or a "Fasting" group (water only). The primary outcome was the instrumental vaginal delivery rate. Secondary outcomes included duration of labor, rate of cesarean delivery, evaluation of maternal hunger, thirst, stress, fatigue, and overall feeling during labor by numeric rating scale (0 worst rating to 10 best rating), rate of vomiting, and hospital length of stay. Statistical analysis was performed on an intention-to-treat basis. The primary outcome was tested with the "Fasting" group as the reference group. The P values for secondary outcomes were adjusted for multiple comparisons. The differences between groups are reported with 99% confidence interval (CI). A total of 3984 women were analyzed (2014 in the Carbohydrate group and 1970 in the Fasting group). There was no difference in the rate of instrumental delivery between the Carbohydrate (21.0%) and the Fasting (22.4%) groups (difference, -1.4%; 99% CI, -4.9 to 2.2). No differences were found between the Carbohydrate and the Fasting groups for the duration of labor (difference, -7 minutes; 99% CI, -25 to 11), the rate of cesarean delivery (difference, -0.3%; 99% CI, -2.4 to 3.0), the rate of vomiting (difference, 2.8%; 99% CI, 0.2-5.7), the degree of self-reported fatigue (difference, 1; 99% CI, 0-2), self-reported hunger (difference, 0; 99% CI, -1 to 1), thirst (difference, 0; 99% CI, -1 to 1), stress (difference, 0; 99% CI, -1 to 1), overall feeling (difference, 0; 99% CI, 0-0), and the length of hospitalization (difference, 0; 99% CI, -1 to 0). Carbohydrate intake during labor did not modify the rate of instrumental vaginal delivery.

Cervical dilation at the time of epidural catheter insertion is not associated with the degree of prolongation of the first or second stages of labor, or the rate of instrumental vaginal delivery.

Epidural analgesia (EA) is an established option for efficient intrapartum analgesia. Meta-analyses have shown that EA differentially affects the first stage of labor but prolongs the second. The question of EA timing remains open. We aimed to investigate whether EA prolongs delivery in total and whether the EA administration timing vis-à-vis cervical dilation at catheter insertion is associated with a modulation of its effects on the duration of the first and second stages, as well as the rate of instrumental vaginal delivery in primiparas and multiparas. A retrospective electronic medical records-based study of 18870 singleton term deliveries occurring in our institution from 2003 to 2015. Cervical dilation was determined within a half-hour of EA administration. We examined whether cervical dilation at EA administration correlated with the duration of the first and/or second stage, with the rate of prolonged second stage, and with the rate of interventional delivery. The study group was stratified to 10 subgroups defined by 1-cm intervals of cervical dilation at EA administration. Logistic regression modeling was applied to analyze the association between EA timing and rate of instrumental delivery while controlling for possible confounders. In primiparas, receiving EA correlated with longer medians of active first stage (+51minutes; P<.001) and second stage (+55minutes; P<.001). In multiparas, median increases in active first stage (+43minutes; P<.001) and second stage (+8minutes; P<.001) were noted. The timing of EA, vis-à-vis cervical dilation (1-10cm) was not associated with a substantial modulation of these effects. Logistic regression showed that cervical dilation at EA was not associated with a higher instrumental vaginal delivery rate. Epidural analgesia prolonged the first and second stages of labor vs no epidural. Having EA was associated with a higher instrumental delivery rate but not with higher rates of maternal or neonatal complications, in primi- and multiparas. Importantly, the timing of EA, vis-à-vis cervical dilation, was not associated with substantial changes in the duration of labor stages or the instrumental delivery rate. Thus, EA may be offered early in the first stage of labor.

Does mild intrahepatic cholestasis of pregnancy require an aggressive management? Evidence from a prospective observational study focused on adverse perinatal outcomes and pathological placental findings

Objective To ascertain the most effective approach in pregnancies complicated by mild intrahepatic cholestasis of pregnancy (mICP) by evaluating rates of adverse perinatal outcomes (APOs) and pathological placental findings. Methods A total of 89 pregnancies complicated by mICP (defined as total serum bile acids (TSBAs) levels <40 µmol/L) were included. One-drug (ursodeoxycholic acid [UDCA]) (n = 49, 55.1%) and combined (UDCA plus S-adenosyl methionine (SAMe)) (n = 40, 44.9%) therapies were compared. Results No differences were found in demographic, obstetric, and placental characteristics. In UDCA plus SAMe group, premature delivery was a common clinical decision (14.3 versus 25%, p-value = .201), with increased rates of instrumental vaginal delivery (VD; 28.6 versus 40%, p-value = .522), but similar cesarean section (CS) rates (26.5 versus 25%, p-value = .498). Mean placental weight was comparable (UDCA, mean 595.7 g, SD 213.1 g versus UDCA plus SAMe, mean 586.4 g, SD 102.9 g, p-value = .875). A total of 110 lesions were identified, 64 in 25 placentas of patients assigned to the UDCA and 46 in 15 placentas of patients managed by UDCA plus SAMe. Placental findings attributable to maternal malperfusion were found in 41/25 and 32/15 cases treated by UCDA and UDCA plus SAMe (165 versus 213%, p-value = .774), pathological fetal vascular supply in 17/25 and 8/15 placentas (68 versus 53%, p-value = .777), and inflammatory lesions in 6/25 and 6/15 cases (24 versus 40%, p-value = .757). Conclusions Pregnancies complicated by mICP and managed by UDCA alone present similar APO rates and placental histopathology if compared with those treated by UDCA plus SAMe, failing to recognize advantages in the combined therapy. Further prospective studies and data sharing from ongoing RTCs could drive changes in therapeutic plan.

Does music during labor affect mode of delivery in first labor after epidural anesthesia? A prospective study.

Listening to music during labor increases the likelihood that primiparas will have a spontaneous vaginal delivery. To examine the effects of exposure to music during labor on the mode of delivery and parturients' stress levels. This prospective, interventional study included 124 low-risk women who were recruited during latent phase of their first labor after epidural anesthesia. Patients were grouped according to their preference to receive music intervention or not. The music intervention included two subgroups: soft classical music and rhythmic music. We evaluated cortisol levels in saliva as a surrogate for stress level and State-Trait Personality Inventory at enrollment and 1-3h later in all women who were still in labor. Delivery and perinatal outcomes were collected from electronic medical records. Correlations between the music intervention and maternal and perinatal outcomes were evaluated. Spontaneous vaginal delivery was significantly more frequent among women listening to music compared to the non-music group (P = 0.035). A trend towards lower rates of cesarean delivery was noted in the music group (P = 0.08), with no difference in instrumental vaginal delivery rates. Stress levels, as measured by questionnaires and by cortisol levels, blood pressure and pulse rate, remained similar throughout the study. No differences were noted between the different genres of music when examining obstetric and perinatal outcomes and stress levels. Listening to music during labor, improves the likelihood of primiparas to have a vaginal delivery regardless of stress level. As this treatment is simple, easy, and harmless to administer, we suggest it may be offered to all patients during labor.

Computerized analysis of cardiotocograms and ST signals is associated with significant reductions in hypoxic-ischemic encephalopathy and cesarean delivery: an observational study in 38,466 deliveries

Intrapartum cardiotocography is widely used in high-resource countries and remains at the center of fetal monitoring and the decision to intervene, but there is ample evidence of poor reliability in visual interpretation as well as limited accuracy in identifying fetal hypoxia. Combined monitoring of intrapartum cardiotocography and ST segment signals was developed to increase specificity, but analysis relies heavily on intrapartum cardiotocography interpretation and is therefore also affected by the previously referred problems. Computerized analysis was developed to overcome these limitations, aiding in the quantification of parameters that are difficult to evaluate visually, such as variability, integrating the complex guidelines of combined intrapartum cardiotocography and ST analysis, and using visual and sound alerts to prompt health care professionals to reevaluate features associated with fetal hypoxia. The objective of the study was to evaluate the effect of introducing a central fetal monitoring system with computerized analysis of intrapartum cardiotocography and ST signals into the labor ward of a tertiary care university hospital in which all women are continuously monitored with intrapartum cardiotocography. The incidence of adverse perinatal outcomes and intervention rates was evaluated over time. In this retrospective cohort study, yearly rates of hypoxic-ischemic encephalopathy, instrumental vaginal delivery, overall cesarean delivery, and urgent cesarean delivery were obtained from the hospital's clinical databases. The rates occurring in the period from January 2001 to December 2003, before the introduction of the central monitoring system with computerized analysis of intrapartum cardiotocography and ST signals (Omniview-SisPorto), were compared with those occurring from January 2004 to December 2014, after the introduction of the system. All rates were calculated with 95% confidence intervals. A total of 38,466 deliveries occurred during this period. After introduction of the system, there was a significant decrease in the number of hypoxic-ischemic encephalopathy cases per 1000 births (5.3%, 95% confidence interval [4.0-7.0] vs 2.2%, 95% confidence interval [1.7-2.8]; relative risk, 0.42, 95% confidence interval [0.29-0.61]), overall cesarean delivery rates (29.9%, 95% confidence interval [28.9-30.8] vs 28.3%, 95% confidence interval [27.8-28.8]; relative risk, 0.96, 95% confidence interval [0.92-0.99]), and urgent cesarean deliveries (21.6%, 95% confidence interval [20.7-22.4] vs 19.2%, 95% confidence interval [18.8-19.7]; relative risk, 0.91, 95% confidence interval [0.87-0.95]). The instrumental vaginal delivery rate increased (19.5%, 95% confidence interval [18.7-20.3] vs 21.4%, 95% confidence interval [21.0-21.9; relative risk, 1.07, 95% confidence interval 1.02-1.13]. Introduction of computerized analysis of intrapartum cardiotocography and ST signals in a tertiary care hospital was associated with a significant reduction in the incidence of hypoxic-ischemic encephalopathy and a modest reduction in cesarean deliveries.

Severe perineal trauma among women undergoing vaginal birth after cesarean delivery: A population-based cohort study.

To examine risk of severe perineal trauma among nulliparous women and those undergoing vaginal birth after cesarean delivery (VBAC). This is a population-based cohort study of all births to women with their two first consecutive singleton pregnancies in Stockholm-Gotland Sweden between 2008 and 2014. Risk of severe perineal trauma was compared between nulliparous women and those undergoing VBAC with severe perineal trauma being the main outcome measure. Associations between indication and timing of primary cesarean delivery and risk of severe perineal trauma in subsequent vaginal birth were analyzed using Poisson regression analysis. The rate of severe perineal trauma among nulliparous women and those undergoing VBAC was 7.0% and 12.3%, respectively. Compared with nulliparous women, those undergoing VBAC were significantly older, had a shorter stature, and gave birth in a non-upright position to heavier infants with larger head circumferences. The rate of instrumental vaginal delivery among nulliparous women and those undergoing VBAC was 19.3% and 20.2%, respectively (P=0.331). An increased risk of severe perineal trauma remained after adjustments among those undergoing VBAC (adjusted risk ratio 1.42, 95% CI 1.23-1.63). Level of risk was not associated with indication (dystocia or signs of fetal distress) of primary cesarean delivery, nor how far the woman had progressed in labor (fully dilated versus planned cesarean delivery) before delivering by cesarean. Compared with nulliparous women, those undergoing VBAC are at increased risk of severe perineal trauma, irrespective of indication and timing of primary cesarean delivery.

Temporal trends in severe maternal and neonatal trauma during childbirth: a population-based observational study

ObjectiveInstrumental vaginal delivery is associated with birth trauma to infant and obstetric trauma to mother. As caesarean delivery rates increased during the past decades, the rate of instrumental vaginal delivery...

Instrumental vaginal delivery in Usmanu Danfodiyo University Teaching Hospital, Sokoto: A ten-year review

Background: Instrumental vaginal delivery is one of the key elements of essential obstetric care that mimics spontaneous vaginal delivery in order to expedite delivery with minimal maternal and neonatal morbidity. The objectives of the study were to determine the rate of instrumental deliveries, the common indications, and compare outcome and complications between forceps and vacuum deliveries. Materials and Methods: This was a retrospective cross-sectional study on instrumental vaginal deliveries carried out in UDUTH over 10 years from January 2007 to December 2016. The list of cases was obtained, the case files were retrieved and relevant information was obtained. Data analysis was done using SPSS version 21. Level of significance was set at P Results: The instrumental vaginal delivery rate was 2.06%. Vacuum deliveries accounted for 83.3% (n = 524) but forceps deliveries accounted for 16.7% (n = 105). The most common indication for both was delayed second stage of labor due to malposition. There was no statistical difference in the mean APGAR scores at 1st and 5th min between babies delivered by vacuum and those delivered by forceps. Majority had no complication and there was no statistical association between the type of procedure and maternal or fetal complications observed during the procedure (χ2 = 3.18, P = 0.2). Conclusion: The rate of instrumental vaginal delivery is much lower than that reported in some centers in Nigeria and globally. Majority of the cases had no complication and there was no significant difference in complications observed between vacuum and forceps deliveries.

A 10-year review of instrumental vaginal delivery at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Background: Instrumental vaginal deliveries are conducted for either maternal or fetal indications to shorten the second stage of labour. Global trends show a diminished instrumental delivery rates. Objectives: To determine the prevalence, indications, complications, and the trend of instrumental vaginal deliveries at the University of Port Harcourt Teaching Hospital. Materials and Methods: This was a retrospective study of 164 women who had an instrumental vaginal delivery over a 10-year period at the University of Port Harcourt Teaching Hospital from January 1, 2008, to December 31, 2017. Data obtained from the labour ward registers and case notes of patients were entered into a proforma and analyzed using EPI-info ver. 7. P value of 0.05 was set as significant at 95% confidence interval. Results: The incidence of instrumental vaginal delivery was 0.67% of all deliveries. Vacuum delivery accounted for 0.63% whereas forceps delivery was 0.04%. Delayed second stage of labour (56; 34.15%) and severe pre-eclampsia/eclampsia (42; 25.61%) were the most common indications. Senior resident trainees conducted majority (121; 73.78%) of the deliveries. The most common maternal complications were perineal tears (13; 50%) and primary postpartum haemorrhage (11; 42.31%). These maternal complications significantly occurred more with vacuum delivery (P value = 0.001). About half of the babies (80; 47.62) had birth asphyxia. Conclusion: The instrumental vaginal delivery rate in this study is very low despite being an alternative to caesarean section. Therefore, efforts should be made toward training and retraining of doctors on this skill to reduce maternal and fetal morbidity associated with the procedure, and also reduce the caesarean section rate.

Trends and operators of instrumental vaginal deliveries in Jos, Nigeria: A 7-year study (1997–2003)

Context: Instrumental vaginal delivery is one of the lifesaving functions of emergency obstetric care to reduce perinatal and maternal morbidity and mortality. Objective: To determine the instrumental vaginal delivery rate, the trends, and the status of their operators in Jos University Teaching Hospital, Nigeria (JUTH) over a 7‑year period (1997–2003). Study Design: A 7‑year cross‑sectional study of obstetric service data from 1 st January 1997 to 31 st December 2003. Patients and Methods: A register was kept for all cases of instrumental deliveries at JUTH from 1 st January 1997 to 31 st December 2003. This register with the patient case notes and neonatal ward records was used to conduct this study. Results: During the study period, there were a total of 17,888 deliveries and 349 instrumental vaginal deliveries, giving a rate of 1.95%. Out of these, 238 (68.2%) were vacuum extraction and 111 (31.8%) were forceps delivery. There was a 67% decline in the use of these instruments from 84 (3.18%) in 1997 to 34 (1.05%) in 2003. Majority 313 (90%) of the procedures were performed by residents (Registrars 49%, Senior Registrars 41%). Consultants performed 10%, and all were in the first four years of the study. Forceps delivery rate 0.62% and vacuum delivery rate was 1.33%. There was a strong negative correlation with the performance of IVD in JUTH. At the current trend, no forceps delivery ( R = −0.93008) will be performed in JUTH in 2005 while only 4 vacuum deliveries ( R = −0.80015) will be conducted in in the same period. Discussion: There is a low instrumental vaginal delivery rate in JUTH with a strong negative correlation in the performance of these procedures. Most procedures are performed by residents, and vacuum is the preferred procedure. Conclusions: Instrumental vaginal delivery in JUTH is a dying art. Training and re‑training of resident doctors on this lifesaving function is recommended. Keywords: Instrumental vaginal delivery; Jos; Nigeria

Combined spinal-epidural analgesia in labour: its effects on delivery outcome

Combined spinal-epidural (CSE) has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome. One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n=55) or Non-CSE (n=55) group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared. The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%). The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group) was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5min was similar in both groups. There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.

Temporal trends in obstetric trauma and inpatient surgery for pelvic organ prolapse: an age-period-cohort analysis

The rates of cesarean delivery have increased over time in industrialized countries, while the rates of instrumental vaginal delivery have declined. Instrumental vaginal delivery and obstetric trauma are risk factors for pelvic floor disorders. We carried out a population-based study to quantify the association between temporal changes in obstetric trauma during childbirth and temporal changes in surgery for pelvic organ prolapse. We designed a retrospective analysis to examine age-specific trends in vaginal and cesarean delivery, obstetric trauma, and surgery for pelvic organ prolapse among all women (pregnant and nonpregnant) in Washington State, from 1987 through 2009. Cases of obstetric trauma (including severe perineal tears and high vaginal lacerations) and inpatient surgery for pelvic organ prolapse were identified among all hospitalizations. Temporal trends and age-period-cohort regression analyses were used to quantify the time period, age, and birth cohort effects among women born from 1920 through1980. From 1987 through 2009, cesarean delivery rates among women aged 15-44 years increased from 12.7-18.1 per 1000 women, vaginal delivery rates remained stable, and instrumental vaginal delivery rates declined from 6.3-3.9 per 1000 women. Obstetric trauma decreased from 6.7 in 1987 to 2.5 per 1000 women aged 15-44 years in 2009. Surgery for pelvic organ prolapse decreased from 2.1 in 1987 to 1.4 per 1000 women aged 20-84 years in 2009. Obstetric trauma rates in 1987 through 1999 among women 15-44 years old were strongly correlated with the rates of surgery for pelvic organ prolapse among women 25-54 years of age 10years later in 1997 through 2009 (correlation coefficient 0.87, P < .001). Similarly, rates of midpelvic forceps delivery in 1987 through 1999 were correlated with the rates of surgery for pelvic organ prolapse 10 years later (correlation coefficient 0.72, P < .01). Regression analyses showed a strong effect of age on surgery for prolapse, temporal decline in surgery, and an effect of birth cohort, as younger cohorts (women born in ≥1965 vs 1940) had lower rates of surgery for pelvic organ prolapse. Temporal decline in instrumental vaginal delivery and obstetric trauma may have contributed to the reduction in surgery for pelvic organ prolapse.