Title: Comparision of Maternal and Neonatal Outcomes in Outlet Forceps and Vacuum Extraction Deliveries
Authors: Dr Chaitra Ramachandra, Dr Roopa, Dr Rekha, Dr Shankaregowda, Dr Nirupama.Y.S
DOI: http://dx.doi.org/10.18535/jmscr/v4i5.15
Aims: To compare the maternal and neonatal out come between forceps and vacuum extractions deliveries. Methods and materials: A total of 100 patients were retrospectively analysed to compare the outcome between forceps (N=50) and vacuum application(N=50) between January 2015 to December 2015 in a tertiary care hospital. The indications for instrumental delivery were fetal distress, failure of descent of head, to cut short second stage of labor, poor maternal efforts. Maternal outcomes were analysed in terms of genital tract injuries (vaginal tears, cervical tears) perineal hematoma, paraurethral tears, postpartum hemorrhage. Neonatal outcomes were analysed in terms of APGAR scores), neonatal trauma (bruise marks, clavicular fractures), Cephalhematoma, Respiratory Distress Syndrome, NICU admissions. and neonatal mortality. The 2 groups were compared using paired T test with p<0.05 is statistically significant. The data were analysed using SPSS soft ware version 16. Results: The most common age group in both the groups were between 21-29 years. Primigravida women with gestational age between 37-40 weeks more commonly required instrumental delivery in both the groups. Fetal Distress was the most common indication(42%) for vaccum application and poor maternal efforts (36%) is the most common indication for forceps. The maternal morbidity was higher in forceps compared to vacuum (58% Vs .40%). Amongst maternal morbidities seen, genital tract injuries (perineal laceration, episiotomy extension and cervical tears) were most common both arms but more in forceps arm which is statistically significant. Amongst the fetal morbidity noted, Neonatal Trauma (Bruises, abrasion, clavicular fracture) was more common in forceps application comparative to vacuum (16% Vs 2%). Cephalhematoma was noted only with vacuum applications (12% Vs 0 %). NICU admission was significantly more in forceps application compare to vacuum (32 % Vs 24%). Conclusion: Vaccum application has a better maternal and neonatal outcome compared to forceps delivery, except cephalhematoma in the neonate which is increasing seen with vaccum application. 1. Editorial. Vacuum versus Forceps. Lance. 1984 Jan 21;(8639):144 2. Lomas J, Enkin M. Variations in operative delivery rates. In: Chalmers I, Enkin M, Keirse MNJC, eds. Effective care in preg and child birth. Vol. 2. Oxford, England: Oxford University Press, 1991:1182-95 3. Johanson RB, Vacuum extraction vs forceps delivery. Oxford, England: The Cochrane library: pregnancy and the childbirth database,2000 4. Johanson RB, Rice C, Doyle M, et al. A randomized prospective study comparing the new vacuum extractor policy with forceps delivery.Br J Obstet Gynaecol.1993;100(6):524-30 5. Giri A, Vaidya A. Maternal and fetal outcomes of vacuum assisted delivery. Postgradua te Medical journal of National Academy of Medical Sciences. 2008;8(1):48-56 6. Prapas N, Kalogiannidis I, Masoura S, et al. Operative vaginal delivery in singlrton term pregnancies: short –term maternal and neonatal outcomes. Hippokratia.2009 Jan;13(1):41-5 7. Akhtar S. Comparison of maternal and infant outcomes between vacuum extraction and forceps deliveries. Pakistan Armed forceps journal.2006;2(1):25-31 8. Mesleh RA, AL Sawadi HM, Kurdi AM. Comparison of maternal and infant outcomes between vacuum extract ion and forceps deliveries.Saudi Medical journal. 2002;23(7):811-3. 9. Achanna S, Monga D. Outcome of forceps delivery versus vacuum extraction a review of 200 cases. Singapore Med J. 1994 Dec;35 (6):605 -8 10. Caeter J.The vacuum extractor. In stud J(Editor).Progress in Obstetrics and Gynaecology. London: Churchill-Livingstone.1990;8:107-26 11. Johnson JH, Figueroa R, Garry D,Ellimian A, Maulik D. immediate maternal and neonatal effects of forceps and vacuum assisted deliveries. Obstet Gynaecol.2004: 103(3):513-8 12. Gachiri JR, Rogo KO. Foetal and maternal outcome of vacuum extraction. East Afr MedJ.1991;68(7):539-46. 13. Baker PN.The place of Mid forceps deliveries in the modern obstetric practice. Current Obst and Gynaec.1995;5:225-9 14. Baskett TF, Fanning CA,Young DC. A Prospective observational study of 1000 vacuum assisted deliveries with the omni cup device. J ObstetGynaecol Can.2008; 300(7):573 -80Abstract
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