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A case–control study on maternal and early neonatal outcomes in instrumental delivery in a tertiary referral hospital

Baby Lekha S, Meera Lekshmi Nair, Mayadevi B.


Background: A vaginal delivery is the safest and most common type of childbirth. It accounts for 80% of births worldwide. This includes both normal birth and operative vaginal delivery. The operative vaginal delivery rates vary from 3% to 13%. The term “normal birth” in academic literature has been used as an unassisted vaginal birth without induction of labor; epidural, spinal, or general anesthesia; or episiotomy. A birth in which the operator uses forceps, a vacuum device, or another instrument to extract the fetus from the vagina, with or without concurrent maternal pushing is called operative vaginal delivery.

Aims and Objectives: The aims and objectives of the study are to compare the maternal and neonatal outcomes of normal delivery and operative vaginal delivery.

Materials and Methods: The prospective case–control study was conducted in a tertiary care center in South India. The study group consists of 393 instrumental and 391 normal deliveries. The American College of Obstetricians and Gynecologists guidelines were used to define outlet vacuum and outlet forceps. Women who had normal vaginal delivery were matched for age and parity was selected as control. All data were collected using a structured interview schedule. Data were analyzed to meet the aims and objectives of the study.

Results: The incidence of vaginal laceration was 4.3% in the instrumental delivery group and 1.3% in the normal delivery group. Other complications in the above groups include post-partum hemorrhage (PPH) (3.8% vs. 1.3%), puerperal complications (7.9% vs. 3.9%), 1-min Apgar >7 (88.7% vs. 95.1%), cephalohematoma (1.5%-1.8% vs. nil), and hyperbilirubinemia (6.4% vs. 4.3%). All the above differences were statistically significant.

Conclusion: Significant maternal complications identified in operative vaginal deliveries were vaginal lacerations and PPH. Neonatal complications identified were low Apgar score at 1 min, cephalohematoma, hyperbilirubinemia, and facial marks.

Key words: Instrumental Delivery; Vacuum Delivery; Forceps Delivery; Operative Vaginal Delivery

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