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.