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Prospective cohort study comparing outcomes between vacuum extraction and second‐stage cesarean delivery at a Ugandan tertiary referral hospital
Author(s) -
Nolens Barbara,
Namiiro Flavia,
Lule John,
van den Akker Thomas,
van Roosmalen Jos,
Byamugisha Josaphat
Publication year - 2018
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12500
Subject(s) - medicine , vacuum extraction , tertiary referral hospital , referral , prospective cohort study , obstetrics , cohort , cohort study , cesarean delivery , stage (stratigraphy) , emergency medicine , family medicine , pregnancy , retrospective cohort study , surgery , paleontology , biology , genetics
Objective To compare maternal and perinatal outcomes between vacuum extraction and second‐stage cesarean delivery ( SSCD ). Methods The present observational cohort study was conducted among women with term vertex singleton pregnancies who underwent vacuum extraction or SSCD at Mulago National Referral Hospital, Kampala, Uganda, between November 25, 2014, and July 8, 2015. Severe maternal outcomes (mortality, uterine rupture, hysterectomy, re‐laparotomy) and perinatal outcomes (mortality, trauma, low Apgar score, convulsions) were compared between initial delivery mode. Results Among 13 152 deliveries, 358 women who underwent vacuum extraction and 425 women who underwent SSCD were enrolled in the study. No maternal deaths occurred after vacuum extraction versus five deaths from complications of SSCD . Vacuum extraction was associated with less severe maternal outcomes compared with SSCD (3 [0.8%] vs 18 [4.2%]; adjusted odds ratio [ aOR ] 0.24, 95% confidence interval [ CI ] 0.07–0.84). Fetal death during the decision‐to‐delivery interval was also less common in the vacuum extraction group (3 [0.9%] vs 18 [4.4%]; aOR 0.24, 95% CI 0.07–0.84); however, the perinatal mortality rate did not differ between the vacuum extraction and SSCD groups (29 [8.4%] vs 45 [11.0%], respectively; aOR 0.83, 95% CI 0.49–1.41). One infant in each group exhibited neurodevelopmental anomalies at 6 months. Conclusion Vacuum extraction had better maternal outcomes and equivalent perinatal outcomes compared with SSCD . These findings encourage re‐introduction of vacuum extraction.