Keywords
Normal Vaginal Delivery; Vacuum Extraction; Outlet Forceps
Abstract
Background:
There is a periodic demand to discourage operative vaginal delivery, however clinical experience suggests that leaving everything to natural forces or scalpel does not accomplish the goal, thus making it an integral part of obstetric care worldwide.
Aims and Objectives:
The present study was aimed to compare the maternal and perinatal outcome in operative vaginal delivery and normal vaginal delivery.
Patients and Method:
It is a prospective study carried out on 200 pregnant women with full term pregnancies admitted in the labor ward of tertiary referral teaching hospital. The patients were divided into 2 groups of 100 each. Group I (Study group) included 100 women delivered either by outlet forceps (50 women) or silastic vacuum (50 women) and Group II (Control group) consisted of 100 women who had normal delivery. The maternal outcome measures were extension of episiotomy, cervical tears, vulval hematoma, altered fecal or urinary continence, perineal discomfort and dyspareunia. Perinatal outcome measures were Apgar score, injuries to newborn and admission to neonatal intensive care unit.
Results:
Maternal complications, extension of episiotomy (p=0.01, RR 2.71, 95% CI 1.19-6.17)), cervical tears (p=0.01, RR 10.0, 95% CI 1.30-76.67) and vulval hematoma (p=0.01, RR 5.00, 95% CI 0.59-42.04)) were significantly more in group I. Apgar score less than seven at five minutes was observed in 5% neonates in group I and none in group II. Neonatal injuries (scalp injuries, facial injuries, cephalhematoma) were seen in 25% cases in-group I and none in group II. 32% neonates in group I and 7% in group II were admitted in neonatal intensive care unit (p=0.00, RR 4.57, 95% CI 2.12-9.87). At three months postpartum the perineal discomfort was complained by 14% and 9% of women and 13% and 8% of the women experienced dyspareunia in the group I and group II respectively.
Conclusion:
Operative delivery cause more complications in both mothers and babies compared to normal delivery, but all these complications are minor in nature. So, instrumentation in the second stage of labor remains useful and alternative procedures to cesarean section, if applied judiciously. There is no difference in terms of perinatal and maternal outcome in forceps and vacuum delivery.
Citation
Singhal SR, Goyal R, Khosla AH and Nanda S. Comparison of Normal Vaginal and Operative Vaginal Delivery. SM J Gynecol Obstet. 2016; 2(1): 1012.