Short Term Maternal & Neonatal outcome of Operative Vaginal Delivery among Mothers who Gave Birth at three Teaching Hospitals in Addis Ababa: a Cross-Sectional Study
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Date
2024-07-05
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Addis Ababa University
Abstract
Background: Operative vaginal deliveries (OVD) are obstetric forceps or vacuum-assisted vaginal births carried out by trained healthcare professionals to speed up the second stage of labor. OVD is carried out when there is a sign of a disorder affecting the mother or the fetus or whenever there is a threat to the mother or the fetus that could be mitigated by second-stage intervention. Fetal distress, protracted labor, maternal tiredness, and any conditions where the mother would not be a good candidate for the Valsalva maneuver are common indications for the use of obstetric forceps and vacuum. OVD can cause severe maternal, neonatal morbidity and even mortality, especially in poor countries like Ethiopia.
Objective: To determine the short-term maternal and neonatal complications related to OVD among mothers who gave birth at three hospitals in Addis Ababa (TASH, ZMH and GMH), Ethiopia.
Method: A facility-based cross-sectional study was conducted at three hospitals in Addis Ababa from January 10, 2024 to July 07, 2024 on 181 mothers who gave birth via OVD and the study participants were recruited using consecutive sampling method. Data was collected from patient interviews, maternal and neonatal charts, the hospital Electronic Data Recording System, and NICU record books by using a structured questionnaire that assesses maternal sociodemographiccharacteristicsobstetric parameters, the circumstances of labor and delivery, and maternal and perinatal outcomes. Data was entered in to SPSS version 25 software for cleaning and analysis. Bivariate analysis was done to identify candidate variables using p<0.25. Multivariable logistic regression was used to control the effect of confounding variables and to identify factors affecting the feto-maternal outcome. Statistical significance was declared at P<0.05.
Result: Among 10,269 total deliveries at three hospitals in Addis Ababa within six month study period, 217(2.1%) mothers gave birth via OVD. forceps and vacuum deliveries account for 0.5% and 1.6% respectively with a ratio of 1:5. Fetal distress (NRFHRP) was the commonest indication for OVD. The magnitude of unfavorable maternal outcomes is found to be 27.6%. FHB before delivery [AOR=3.8, 95% CI 1.49, 9.54], level of profession performing the delivery [AOR=10.1, 95% CI 1.99, 101.95] & neonatal birth trauma [AOR=13.8, 95% CI 3.9, 48.9] found significant association with unfavorable maternal outcome. The proportion of Unfavorable neonatal outcome of the study is 19.3 %. Number of pulls attempted for delivery [AOR=5.9, 95% CI 1.93, 18.24] and maternal perineal tear [AOR=9.5, 95% CI 2.4, 16.2] found significant association with unfavorable neonatal outcome.
Conclusion: The magnitude of OVD is found to be 2.1% and NRFHRP is the commonest indication. The proportion of unfavorable maternal & neonatal outcome is 27.6% & 19.3% respectively.FHB before delivery, level of profession performing the delivery and neonatal birth trauma are factors that strongly predict maternal unfavorable outcome. Whereas number of pulls attempted for delivery and maternal perineal tear are significant factors associated with unfavorable neonatal outcomes.
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SHORT TERM MATERNAL & NEONATAL