Changing Trend of Instrumental Vaginal Deliveries at Patan Hospital

Lamichhane, Basant; Singh, Ajeet

doi:10.3126/njog.v10i2.14333

Cited by 3 publications

(3 citation statements)

References 3 publications

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“…Though vacuum assisted delivery is listed as a component of BEOC and CEOC program, there is hesitancy in its use. 15 The justifiable explanations for decreasing trends could be poor mastering of the art and fear of related disastrous complications. Again, new practitioners and residents are reluctant in doing operative vaginal delivery thereby increasing the caesarean delivery rate.…”

Section: Discussionmentioning

confidence: 99%

Vacuum Deliveries: A Retrospective Study on Immediate Maternal and Neonatal Outcomes in Western Regional Hospital, Pokhara

Kafle¹,

Pageni²

2020

Med. J. Pokhara Acad. Health Sci.

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Introduction: The overall rate of operative vaginal delivery is diminishing, but the proportion of operative vaginal deliveries conducted by vacuum is increasing. As forceps assisted delivery requires more skill and has more complications on maternal genital tract, this procedure is being less frequently practiced. By the 1970s, the vacuum extractor virtually replaced forceps for assisted deliveries in most of the countries. Vacuum assisted vaginal delivery reduces maternal as well as neonatal morbidity and mortality in prolonged second stage of labor, non reassuring fetal status and maternal conditions requiring a shortened second stage. Materials and Methods: This was a record based retrospective study of 217 vacuum assisted vaginal deliveries conducted at Western Regional Hospital, Pokhara for a period of one year. Patient’s discharge charts were studied and details of indications for vacuum application, maternal genital tract status, amount of blood loss, postpartum hemorrhage (PPH), birth weight, APGAR score at 1 and 5 minute, Neonatal Intensive Care Unit (NICU) admission and neonatal death (NND) were collected. Descriptive data analysis was done using SPSS program. Results: Out of the 8778 deliveries conducted during the study period, 217 (2.47%) cases were vacuum assisted vaginal deliveries. No significant adverse obstetrics outcomes were noted. Most frequent indication was fetal distress which accounted for 53.9%. Though 3rd/4th degree perineal tears were less, episiotomy rate was higher (69.1%). Regarding neonatal outcomes, mean APGAR score at 5 minute was 7.42 ± 1.11 SD and 12.4% neonates had APGAR score of less than 7 at 5 minute. Conclusion: When standard criteria for vacuum application are met and standard norms are followed, there is no evidence of adverse obstetrics outcomes in vacuum assisted vaginal delivery. Prompt delivery by a skilled clinician in non reassuring fetal cardiac status reduces neonatal morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Vacuum Deliveries: A Retrospective Study on Immediate Maternal and Neonatal Outcomes in Western Regional Hospital, Pokhara

Kafle¹,

Pageni²

2020

Med. J. Pokhara Acad. Health Sci.

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“…Studies show that women living in urban, having higher levels of education, on highest wealth quantile and nulliparous are the one who are going through unnecessary cesarean delivery [28][29]. In some hospitals, for instance, in Patan Hospital and Tribhuvan University Teaching Hospital there are growing trend of cesarean section rate from 23% in 2005 to 44% in 2014 and 17% in 2005 to 25% in 2010 respectively indicating declining in normal spontaneous and instrumental vaginal deliveries [30,31]. This indicates that unknowingly these women are becoming the victim of obstetric violence that they are unaware of so do the medical professionals are becoming perpetrators, which are they are unaware of because of own ignorance [32,33].…”

Section: Journal Of Gynecology and Women's Healthmentioning

confidence: 99%

Untitled

2017

JGWH

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particularly when not justified by a medical condition, expose women to well-documented risks of death, disability and depression including increased health costs [3][4][5].Many studies have shown that women who have cesarean section without medical necessities are at high risk of higher rates of infection, pain, pre-hospitalization, breastfeeding challenges, and complications in future pregnancies and even death of childbearing women [6][7][8][9][10][11][12][13]. Additionally, babies delivered by cesarean sections have higher rates of hospital admission, need for ventilation, respiratory morbidity and mortality [6,[14][15][16]. Cesarean section born babies are more likely to have long-term negative health effects, such as asthma, type-1 diabetes, obesity, metabolic diseases and lead to unexplained stillbirths in the second pregnancy [3,[17][18][19][20]. These risks explain why cesarean on demand or without any maternal and fetus conditions is

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“…CS rates decreased only in two countries: Guinea, from 3.3% to 2.4%; and Nigeria, from 2.9% to 2%. Zimbabwe maintained the rate at 6% and all other countries increased their use of CS 5 . Especially in Urban area, ceserean birth is in rising trend in Nepal.…”

Section: Introductionmentioning

confidence: 99%

Rising Rate of Ceserean Section in Nepal

Singh¹

2019

TIJPH

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Caesarean section is one of the most common and lifesaving surgeries performed in modern obstetrics. In a developing country like Nepal where health care resources are limited, this rising trend definitely has major implication but it is essential to perform when complications arise during pregnancy and labour without this large number of women and their unborn babies die every year, especially in low-income countries. The World Health Organization suggests 10-15% cesarean section rate and has suggested to be done only when justified by a medical condition 2 . It states that, at a population level, if cesarean section rates higher than 10% does not reduce the maternal and neonatal mortality rates, and it should be performed only when medically justified. Otherwise unnecessary health of mother and babies including social and economic implications would challenge childbearing women, babies, their families and the state. Recently in Nepal there is a sharp rising trend of cesarean section rates from 20 to 81% in different hospitals especially in the private setting indicating over-medicalization of childbirth unnecessarily performing without medically justified. This arise the issue of human rights violence of childbearing women and professional integrity of a practitioner and safety of the clients. The World Health Organization recommended use of the Robson criteria which would be one of the best strategies in reducing the frequency of the procedure that should include avoidance of medically unnecessary primary cesarean section and improving case selection for induction and prelabour cesarean section besides educating childbearing women and their families about the consequences of unnecessary request of the procedure.

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Changing Trend of Instrumental Vaginal Deliveries at Patan Hospital

Cited by 3 publications

References 3 publications

Vacuum Deliveries: A Retrospective Study on Immediate Maternal and Neonatal Outcomes in Western Regional Hospital, Pokhara

Vacuum Deliveries: A Retrospective Study on Immediate Maternal and Neonatal Outcomes in Western Regional Hospital, Pokhara

Untitled

Rising Rate of Ceserean Section in Nepal

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