Fetal and maternal outcomes of vacuum assisted deliveries at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Vacuum assisted deliveries (VAD) are vaginal deliveries that are accomplished with the use of a vacuum device. This avoids caesarean section and its associated morbidity and implications on future pregnancies. Vacuum deliveries account for approximately 0.2 to1.2% of vaginal deliveries in sub- Saharan Africa. There has been a rise in the number of vacuum deliveries due to increased training in Kenya in the recent past. Objectives: To determine the indications, labor and procedural characteristics and feto-maternal outcomes of vacuum deliveries at MTRH. Methods: A hospital– based descriptive study on VAD of parturients of ≥ 37 weeks gestational age and their neonates followed up for 24 hours. A census was conducted in one year from 31st January 2018 to 28th February 2019. Data collection was done in labour ward from participant’s file, observation of the procedure and questionnaires were filled by research assistants. Categorical variables were summarized with frequencies, median and their interquartile ranges and association assessed using Pearson’s Chi Square test / Fisher’s exact test. Continuous variables were summarized using the mean and their standard deviation. Results are presented using tables and graphs Results: There were 188 participants with a mean age of 23 years. 58.5% were nulliparous. There were 180 successful and 8 failed VAD. Indications for VAD were prolonged second stage of labor, maternal exhaustion and non- reassuring fetal status at 42%, 36.2% and 11.7% respectively. Use of a rigid cup was associated with increased maternal injuries. (p=0.046). Failed VAD resulting in CS was associated with fetal caput succedaneum (p=0.025) and longer decision to delivery interval (p=0.034). The average fetal birth weight was 3200 grams. Admission to the Newborn Unit was 19.1% with birth asphyxia as the commonest diagnosis at 50%. Perinatal mortality occurred at 6.9 %. Genital injuries were the commonest maternal morbidity at 60.6%. Obstetric Anal Sphincter Injuries occurred in 23.7% of the participants. 18.6% of the participants had postpartum hemorrhage and the main cause was trauma. Conclusion: The commonest indication of vacuum assisted delivery was prolonged second stage of labor. Presence of caput succedaneum and longer duration of vacuum extraction was associated with VAD failure. Superficial scalp injuries were the commonest morbidity due to this procedure. Genital tract injuries were the major maternal morbidity and main cause of PPH in this study. Recommendations: There is need for proper assessment of parturients in order to reduce cases of failed vacuum extraction. Continuous training of the health-care provider in the art of vacuum extraction to improve fetal and maternal outcomes.