Goossens, T. (Tamar) (2015) Vacuum extraction versus caesarean section in second stage of labour in Mulago Hospital, Uganda: a cohortstudy - comparing maternal and perinatal outcomes. thesis, Medicine.
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Abstract
Background: Prolonged second stage of labour and fetal distress are important causes of maternal and perinatal morbidity and mortality. Delay in the second stage of labour can be shortened by means of a caesarean section (CS) or an instrumental delivery such as vacuum extraction (VE). VE is underused in Africa and attempts to introduce this procedure are often met with skepticism and concern about unfavorable perinatal outcome. In Mulago Hospital, Uganda, VE was recently reintroduced. Data on perinatal and maternal complications of VE in low-resource settings is scarce. Aims: (1) To investigate maternal and perinatal outcome of VE in a low-resource setting. (2) To compare these outcomes with outcomes of CS, the alternative treatment for prolonged second stage of labour or fetal distress in the second stage of labour. (3) To evaluate the maternal perception of the delivery method used. Method and design: A hospital-based cohort study. Mothers in the second stage of labour with insufficient progress or fetal distress underwent VE or CS, as indicated by their doctor. Together with their newborns they were followed until six weeks after delivery. Outcome measures of interest were maternal complications, perinatal death and admissions to the neonatology unit, maternal pain scores and value of her delivery experience. Results: A total of 232 mothers were included in this study, of which 121 underwent VE and 111 CS. Overall more maternal complications were seen in the CS group. In the first 24 hours after delivery post-partum hemorrhage was seen in 7% in the VE-group and 23%in the CS-group (p=0.0003). In puerperium wound complications were seen in 4% of mothers in the VE-group and 15% in the CS-group (p=0.0034). In the VE group, 117 babies were included and 109 in the CS group. Perinatal death rate in infants born after VE and CS was respectively 8% and 16% (p = 0.0937). After excluding the cases with fetal distress perinatal death rate was respectively 5% and 14% (p = 0.047). Admissions to the neonatology unit are similar for both groups. The majority of mothers in both groups would recommend a VE above CS to their friends. Conclusion: Our findings show that perinatal and maternal outcomes after VE are at least as good as outcomes after CS in the second stage of labour in a low-resource setting. Maternal complications are significantly less common in the VE group. Post-partum, the majority of mothers in both groups would recommend a VE above CS to others. We recommend the use of VE for prolonged second stage of labour or fetal distress in the second stage of labour in our setting.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Rheenen, Dr. P.F. van |
| Supervisor name: | Nolens, Barbara and Obstetrician/Gynaecologist Mulago Hospital, Uganda |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:03 |
| Last Modified: | 25 Jun 2020 11:03 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2331 |
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