Vacuum Assisted Vaginal Delivery: Incidence, Maternal and Neonatal Complications in Muhimbili National Hospital, Dar Es Salaam, Tanzania

Abstract

Background: Vacuum assisted vaginal delivery is defined as vaginal delivery accomplished by vacuum extractor after creating a vacuum between the vacuum cup and the fetal scalp. It is commonly used to expedite birth for the benefit of mother and the baby. The frequency of vacuum assisted vaginal delivery differs from one country to another, and within the country, from one obstetric unit to another and the ideal rate is unknown. The results of this study inform, and also serve as a baseline for vacuum assisted vaginal delivery trend and maternal and neonatal complications in Muhimbili National Hospital (MNH). Objective: This study was done to describe Incidence, Indications, Maternal and neonatal complications from vacuum assisted vaginal delivery at Muhimbili National Hospital Dar es salaam (DSM), Tanzania. Methodology: A retrospective descriptive hospital based study, was conducted in Muhimbili National Hospital, DSM, Tanzania. Records of 211 women delivered by vacuum assisted vaginal delivery from January 2012 to December 2014 meeting inclusion criteria were included. Data was collected using a check list and analysed using SPSS data base program version 20. Data collection was done for a period of 3months from September to December 2015. Data was summarized and presented in tabular form, Bar chart, and Pie chart using frequencies and percentages. Result: Total deliveries during the study period were 24922. Among all deliveries 231 were vacuum assisted vaginal deliveries giving an incidence of 0.93%; only 211(91.34%) were retrieved and their information was used in this study where by a case study was done. The ages of the Women raised between 17 to 45 respectively, the median age was 27.1. A higher proportional of women 97(45.9%) who had vacuum assisted vaginal delivery had perineal tears and most72 (34.1%) of them had first degree tear and second degree tear 22(10.4%) and (24.6%) episiotomy was done before procedure. Other common presented maternal complications were postpartum haemorrhage (13.3%) followed by vaginal laceration (6.6%) and cervical tear (2.4%). Among all vacuum assisted vaginal deliveries which occurred in 2012 to 2014, 29(13.7%) were done to fresh still births. So only 182(88.3%) were considered in counting neonatal complications due to vacuum assisted Vaginal delivery. Results showed that 43(23.6%) had lower Apgar score and 43(23.6%) were admitted to Neonatal intensive care unit (NICU) due to low score. Prolonged second stage of labour was the most common reported indication for vacuum assisted vaginal delivery with the rate of 84(39.81%) while the least common reported indication was foetal distress in the second stage of labour 34(16.1%). Conclusion: Use of vacuum assisted vaginal delivery is low; the most presented maternal complications were postpartum haemorrhage, cervical tear, and perineal tear. Reported neonatal complications were low Apgar score and admission to NICU due to low score and maternal and neonatal complications were minimal. Recommendations: A health care provider should report on neonatal outcome following vacuum assisted vaginal delivery. The Procedure is safe and encouraged to cut down caesarean sections. Further study on this topic especially on neonatal examination and follow up on NICU following vacuum assisted vaginal delivery.