SHORT TERM MATERNAL AND PERINATAL OUTCOMES OF INSTRUMENTAL VAGINAL DELIVERIES AT SAINT PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE

Abstract

Abstract Background: Instrumental vaginal delivery refers to a delivery in which the operator uses a forceps or a vacuum device to assist the mother in transitioning the fetus to extra uterine life. Though instrumental delivery is one of the frequent features of obstetrics practice in tertiary levels of care even in developing countries, currently available evidence and attempts to address maternal and fetal complications associated with this procedure are limited in our set up. Objective: To determine short term maternal and neonatal outcomes of instrumental vaginal deliveries in St. Paul’s Hospital Millennium Medical College. Method: A cross sectional study was conducted from October 2018-January 2019, on 238 women who delivered with assistance of instrumental delivery in SPHMMC using purposive sampling method. The data was entered using Epidata version 3.1 and analyzed using SPSS version 22 software. Descriptive statistics were conducted to summarize the sample characteristics. Backward stepwise logistic regression model was fitted and AOR with 95% CI was calculated to identify the associated factors. P-value <0.05 was taken as a cut of point for statistical significance. Ethical clearance was obtained from IRB of SPHMMC and informed consent was taken from the study participants. Result: There were 241 IVDs among 3,165 total deliveries during the study period with ID rate of 7.61%. Out of this 238 of the mothers were included in the study. The maternal complication rate associated with IVD was 15.6% (37/238) whereas fetal complication was 28.15 % (67/238). The most common maternal complication was 2nd degree perineal tear (45.9%), followed by failed vacuum (21.6%) and the commonest neonatal complication was asphyxia (34.3%), followed by cephalhematoma (31.34%). The result showed that sequential use of ID [AOR=4.82; (95%CI=2.10-27.29)], was significantly associated with IVD related maternal complication. On the other hand fetal position of LOP [AOR=12.43;( 95% CI=2.05-18.76)], number of pulls two and three [AOR=1.06 ;( 95%CI= 1.01-1.59)] and [AOR=1.19;( 95%CI= 1.05-1.67)] respectively and sequential use of ID [AOR=6.43; (95%CI=1.19-14.73)] were significantly associated with fetal complications. Conclusion: Overall, maternal and fetal complications of instrumental vaginal delivery among mothers and neonates who delivered through ID in SPMMCH are high. Key words: Forceps, Vacuum, Instrumental delivery, Perinatal outcome, Maternal outcome