Comparison of Maternal and Neonatal Outcome in Forceps versus Ventouse Assisted Vaginal Delivery

Abstract

Objectives: To compare the maternal and neonatal outcome following ventouse and forceps- assisted vaginal deliveries in singleton term pregnancies. Study Design: A cross- sectional study. Duration and Place of study: It was conducted at the Ob/Gynae unit-III of Jinnah hospital, Lahore from June 2011 to May 2013. Patients and Methods: All patients who underwent instrumental vaginal delivery during this period, fulfilling the inclusion criteria were studied. Main maternal outcomes were perineal tears while the main neonatal outcomes were Apgar score at 1 minute and at 5 minutes after birth. Neonatal outcome included record of cephalhematoma, shoulder dystocia and need for admission to NICU. In addition to the above, maternal age, gestational age, parity and booking status were also recorded along with the indication for instrumental vaginal delivery for both ventouse and forceps delivery groups. Data was entered into SPSS-15. Percentages were calculated for all the above variables except maternal age and gestational age for which mean + SD were calculated. Chi -square test was used for qualitative variables to assess any difference between the two groups. P-value of equal to or <0.05 considered to be significant. Results: A total of 80 patients underwent ventouse delivery while 120 patients with forceps delivery were included. Mean maternal ages were 25.7+ 4.33 yrs and25.05+3.47yrs in ventouse and forceps group respectively. 54(67%) and 95(79.16%) were primiparous in ventouse and forceps group respectively. 35(43.7%) were booked cases in ventouse group while this number was 53(44.2%) in forceps group. Fetal distress was the commonest indication of instrument application in 60(75%) and 108(90%) cases in ventouse and forceps group respectively. 16(20%) and 35(29.16%) neonates had Apgar score of <7 at 1 minute in ventouse and forceps group respectively. Apgar score of <7 at 5 minute was observed in 10(12.5%) of ventouse group while 14(11%) of forceps group. 2.5 % (n=2) and 1.66% (n=2) of neonates had shoulder dystocia in ventouse and forceps group respectively. Cephalhematoma was observed in 4(5%) of ventouse group while it was 1.5% (n=2) in forceps group. 11% (n=9) and 10% (n=12) of neonates admitted to NICU in ventouse and forceps group respectively.  No case of maternal 3^rd degree perineal tear observed in ventouse group while 3(2.5%) of patients had 3^rd degree perineal tears in forceps group. Conclusion: Forceps deliveries are more associated with maternal morbidity while neonatal trauma is commoner among those delivered by vacuum extraction however there seems to be no difference in neonatal admission to NICU.