Background: Prolonged second stage of labour is an important cause of maternal and perinatal morbidity and mortality. Vacuum extraction (VE) and second- stage caesarean section (SSCS) are the most... Show moreBackground: Prolonged second stage of labour is an important cause of maternal and perinatal morbidity and mortality. Vacuum extraction (VE) and second- stage caesarean section (SSCS) are the most commonly performed obstetric interventions, but the procedure chosen varies widely globally. Objectives: To compare maternal and perinatal morbidity, mortality and other ad-verse outcomes after VE versus SSCS.Search Strategy: A systematic search was conducted in PubMed, Cochrane and EMBASE. Studies were critically appraised using the Newcastle- Ottawa scale. Selection Criteria: All artictles including women in second stage of labour, giving birth by vacuum extraction or cesarean section and registering at least one perinatal or maternal outcome were selected.Data Collection and Analysis: The chi-square test, Fisher exact's test and binary logistic regression were used and various adverse outcome scores were calculated to evaluate maternal and perinatal outcomes.Main Results: Fifteen articles were included, providing the outcomes for a total of 20 051 births by SSCS and 32 823 births by VE. All five maternal deaths resulted from complications of anaesthesia during SSCS. In total, 133 perinatal deaths occurred in all studies combined: 92/20 051 (0.45%) in the SSCS group and 41/32 823 (0.12%) in the VE group. In studies with more than one perinatal death, both conducted in low-resource settings, more perinatal deaths occurred during the decision- to- birth interval in the SSCS group than in the VE group (5.5% vs 1.4%, OR 4.00, 95% CI 1.17- 13.70; 11% vs 8.4%, OR 1.39, 95% CI 0.85- 2.26). All other adverse maternal and perinatal outcomes showed no statistically significant differences.Conclusions: Vacuum extraction should be the recommended mode of birth, both in high-income countries and in low-and middle-income countries, to prevent un-necessary SSCS and to reduce perinatal and maternal deaths when safe anaesthesia and surgery is not immediately available. Show less
Kalisa, R.; Rulisa, S.; Akker, T. van den; Roosmalen, J. van 2019
Unnecessary interventions to manage prolonged labor may cause considerable maternal and perinatal ill-health. We explored how prolonged labor was managed in three rural Rwandan hospitals using a... Show moreUnnecessary interventions to manage prolonged labor may cause considerable maternal and perinatal ill-health. We explored how prolonged labor was managed in three rural Rwandan hospitals using a partograph. A retrospective chart review was done to assess whether (A) the action line on the partograph was reached or crossed, (B) artificial rupture of membranes (ARM) performed, (C) oxytocin augmentation instituted, and (D) vacuum extraction (VE) considered when in second stage of labor. Adequate management of prolonged labor was considered if three clinical criteria were fulfilled in the first and four in the second stage. Out of 7605 partographs, 299/7605 women (3.9%) were managed adequately and 1252/7605 women (16.5%) inadequately for prolonged labor. While 6054 women (79.6%) remained at the left of the alert line, still 1651/6054 (27.3%) received oxytocin augmentation unjustifiably. Amongst women whom were managed adequately for prolonged labor until their cervical dilatation plot reached or crossed the action line. In 115/299 women (38.5%), however, second stage of labor was reached but CS performed without a trial of VE. In 1252/7605 women (16.5%) management was inadequate, when their cervical dilatation plot reached between the alert and action lines, 495/1252 women (39.5%) did not reach the second stage of labor and remained left of the action line had their membranes ruptured and labor augmented, and gave birth by CS. CS was, however, also performed in 151/1252 women (12.1%) whose membranes were still intact. We recommend training for more appropriate decision-making during labor to prevent unnecessary CS and proper use of ARM, oxytocin augmentation and VE can be provided safely. Show less
Nolens, B.; Akker, T. van den; Lule, J.; Twinomuhangi, S.; Roosmalen, J. van; Byamugisha, J. 2019
ObjectivesTo investigate what women who have experienced vacuum extraction or second stage caesarean section (CS) would recommend as mode of birth in case of prolonged second stage of labour... Show moreObjectivesTo investigate what women who have experienced vacuum extraction or second stage caesarean section (CS) would recommend as mode of birth in case of prolonged second stage of labour.MethodsA prospective cohort study was conducted in a tertiary referral hospital in Uganda. Between November 2014 and July 2015, women with a term singleton in vertex presentation who had undergone vacuum extraction or second stage CS were included. The first day and 6 months after birth women were asked what they would recommend to a friend: vacuum extraction or CS and why. Outcome measures were: proportions of women choosing vacuum extraction vs. CS and reasons for choosing this mode of birth.ResultsThe first day after birth, 293/318 (92.1%) women who had undergone vacuum extraction and 176/409 (43.0%) women who had undergone CS recommended vacuum extraction. Of women who had given birth by CS in a previous pregnancy and had vacuum extraction this time, 31/32 (96.9%) recommended vacuum extraction. Six months after birth findings were comparable. Less pain, shorter recovery period, avoiding surgery and the presumed relative safety of vacuum extraction to the mother were the main reasons for preferring vacuum extraction. Main reasons to opt for CS were having experienced CS without problems, CS presumed as being safer for the neonate, CS being the only option the woman was aware of, as well as the concern that vacuum extraction would fail.ConclusionsMost women would recommend vacuum extraction over CS in case of prolonged second stage of labour. Show less
Nolens, B.; Akker, T. van den; Lule, J.; Twinomuhangi, S.; Roosmalen, J. van; Byamugisha, J. 2018
