Prevalence, Indications and Fetal Outcome of Operative Vaginal Delivery in Sub-saharan Africa, Systematic Review, and Meta-analysis

Abstract

Background Operative vaginal deliveries are the mode of the deliveries accomplished with either a vacuum device or forceps to the fetal head and outward traction generating a force that augments maternal pushing to deliver the fetus vaginally. As a result, this systematic review and meta-analysis aimed to assess the prevalence, indications, and fetal outcome of operative vaginal delivery in sub-Saharan Africa. Method Search for relevant articles was done by using online databases like Google Scholar, PubMed, HINARI and Web of Science, African OnLine, and other gray and online repositories of Universities in Africa. The JOANNA Briggs Institute standard data extraction format was used to extract and appraise high-quality articles before being included in this study. The heterogeneity of the studies was tested by the Cochran Q test and I2 statistical test. The publication bias was tested by a Funnel plot and Egger’s test. The overall pooled prevalence, indications, and fetal outcome of operative vaginal delivery along a 95% CI using forest plots and tables. Result The overall pooled prevalence of operative vaginal delivery in sub-Saharan Africa was 7.98% (95% CI; 5.03–10.65; I2 = 99.9%, P < 0.001). The indications of operative vaginal delivery in sub-Saharan African countries include the prolonged second stage of labor 32.81%, non-reassuring fetal heart rate 37.35%, maternal exhaustion 24.81%, big baby 22.37%, maternal cardiac problem 8.75%, and preeclampsia/eclampsia 2.4%. Regarding the fetal outcome, favourable fetal outcomes was 55% (95CI: 26.04, 84.44), p = < 0.56, I2: 99.9%). From those births with unfavorable outcomes, the need for the resuscitation of new-born was highest 28.79% followed by poor 5th minute Apgar score, NICU admission, and fresh stillbirth, 19.92%, 18.8%, and 3.59% respectively. Conclusion The overall prevalence of OVD in sub-Saharan Africa was slightly higher compared to other countries. The prolonged second stage of labor (PSSOL), maternal exhaustion, maternal cardiac problem, preeclampsia and eclampsia, fetal asphyxia, and a big baby (> 4000g) were the indications for operative vaginal delivery. Poor 5th minute Apgar score 19.92%, admission to NICU 18.8%, need of the new-born resuscitation 28.78%, and fresh new-born 3.59% were unfavourable fetal outcomes after application of OVD. To reduce increased applications and adverse fetal outcomes of OVD, capacity building for obstetrics care providers and drafting guidelines are required.