Trends in Operative Vaginal Delivery at Dubai Hospital: 5-year Retrospective Study

Abstract

Background: Operative vaginal delivery (OVD) refers to the use of forceps or a vacuum during vaginal delivery, a fundamental component of emergency obstetric and newborn care. But, worldwide, there is a declining trend in the instrumental delivery and increase in cesarean delivery.Objective: This study aims to assess the current trends, risks, and complications associated with OVD at Dubai Hospital, United Arab Emirates (UAE). Study design: Retrospective observational study of all women who delivered by OVD over a 5-year period from 2018 to 2022. We collected data on maternal demographics, maternal, and neonatal outcomes and total deliveries. Results: During the study period, 2.8% of women had successful operative vaginal deliveries. Our incidence remained the same during the study period. We had a total of 273 instrumental deliveries during the study period; out of this, 54.6% were delivered by metal cup, 42% by Kiwi, and 3.3% by forceps. We also noticed the preference of Kiwi over the years as compared with metal vacuum. The most common indication for OVD was fetal distress, accounting for 85.7% of cases. We also noticed a significant increase in OVD for patients on epidural analgesia (14.7% in 2018 vs 43.6% in 2022). Among the patients who underwent instrumental deliveries, 13 cases (4.8% of the total) were identified with 3rd-degree perineal tears. Multiple vaginal lacerations and cervical tears were observed in 25% of the cases. Major perineal tears, the need for suturing in operation theater, and the need for blood transfusion were seen more in women delivered by metal cups as compared with Kiwi and forceps, but not statistically significant. About 13% babies developed neonatal jaundice, and 18.3% babies needed admission to the neonatal intensive care unit (NICU). Shoulder dystocia is more common in babies delivered by metal cups (4.6%). Conclusion: Operative vaginal delivery remains a crucial component of obstetric care, with stable incidence. We observed a shifting preference toward the Kiwi vacuum extractor over metal cups while fetal distress remained the primary indication.