Dataset Information

A prospective cohort study of the morbidity associated with operative vaginal deliveries performed by day and at night.

ABSTRACT:

Objective

To evaluate maternal and neonatal outcomes associated with operative vaginal deliveries (OVDs) performed by day and at night.

Design

Prospective cohort study.

Setting

Urban maternity unit in Ireland with off-site consultant staff at night.

Population

All nulliparous women requiring an OVD with a term singleton fetus in a cephalic presentation from February to November 2013.

Methods

Delivery outcomes were compared for women who delivered by day (08:00-19:59) or at night (20:00-07:59).

Main outcome measures

The main outcomes included postpartum haemorrhage (PPH), anal sphincter tear and neonatal unit admission. Procedural factors included operator grade, sequential use of instruments and caesarean section.

Results

Of the 597 women who required an OVD, 296 (50%) delivered at night. Choice of instrument, place of delivery, sequential use of instruments and caesarean section did not differ significantly in relation to time of birth. Mid-grade operators performed less OVDs by day than at night, OR 0.60 (95% CI 0.43 to 0.83), and a consultant supervisor was more frequently present by day, OR 2.26 (95% CI 1.05 to 4.83). Shoulder dystocia occurred more commonly by day, OR 2.57 (95% CI 1.05 to 6.28). The incidence of PPH, anal sphincter tears, neonatal unit admission, fetal acidosis and neonatal trauma was similar by day and at night. The mean decision to delivery intervals were 12.0 and 12.6 min, respectively.

Conclusions

There was no evidence of an association between time of OVD and adverse perinatal outcomes despite off-site consultant obstetric support at night.

SUBMITTER: Butler K

PROVIDER: S-EPMC4216855 | biostudies-literature | 2014 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

A prospective cohort study of the morbidity associated with operative vaginal deliveries performed by day and at night.

Butler Katherine K Ramphul Meenakshi M Dunney Clare C Farren Maria M McSweeney Aoife A McNamara Karen K Murphy Deirdre J DJ

BMJ open 20141029 10

<h4>Objective</h4>To evaluate maternal and neonatal outcomes associated with operative vaginal deliveries (OVDs) performed by day and at night.<h4>Design</h4>Prospective cohort study.<h4>Setting</h4>Urban maternity unit in Ireland with off-site consultant staff at night.<h4>Population</h4>All nulliparous women requiring an OVD with a term singleton fetus in a cephalic presentation from February to November 2013.<h4>Methods</h4>Delivery outcomes were compared for women who delivered by day (08:00 ...[more]

PMID: 25354825

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Project description:BackgroundVenous thromboembolism (VTE) is a leading cause of maternal mortality and morbidity, with the highest incidence occurring during the postpartum period. This study compared the ability of two types of low-molecular-weight heparin, enoxaparin and bemiparin, to decrease the incidence of VTE following elective caesarean section, emergency caesarean section, and vaginal delivery in women who had risk factors for thromboembolism.MethodsIn this prospective clinical trial using a sequential group allocation method, 7020 haemodynamically stable women delivered vaginally or abdominally at the Maternity Teaching Hospital, Kurdistan region, Erbil, Iraq, between May 1, 2012, and November 1, 2013. These women had risk factors for VTE and were allocated to the following groups: treatment with 3500 IU/day of bemiparin, 4000 IU/day of enoxaparin, or no intervention (control). The first dose was administered 6 hours after vaginal or abdominal delivery, or 8 hours after delivery in women receiving spinal anaesthesia. Subsequent doses were administered daily for up to 6 days. The incidence of VTE was assessed for up to 40 days postpartum. Data were analyzed using the Statistical Package for Social Sciences version 19. Proportions were compared using the chi square test of association or Fisher's exact test. Binary logistic regression analysis was used with VTE as the dependent variable.ResultsVTE occurred in 1 (0.042%) woman in the bemiparin group, two (0.085%) women in the enoxaparin group, and nine (0.384%) women in the control group (P = 0.017). Regression analysis showed that women on bemiparin (OR = 0.106; 95% CI = 0.013-0.838) and enoxaparin (OR = 0.226; 95% CI = 0.049-1.049) were at lower risk of developing VTE than control women. Adverse events in the enoxaparin group included wound dehiscence, haematoma, and separation. None of these occurred in the bemiparin group.ConclusionsPostpartum bemiparin is significantly effective as a prophylaxis for VTE. Wound complications develop after use of enoxaparin, but not after bemiparin.Trial registrationClinicalTrials.gov; Identifier: NCT01588171 ; date: April 26, 2012.

Project description:Background Operative vaginal deliveries represent an alternative to address problems during the second stage of labor. Clinicians have access to two different instruments obstetrics forceps and vacuum which should be conducted with indication. Understanding the pooled prevalence of operative vaginal deliveries, its indications, and outcomes would help in adopting suitable measures to reduce operative vaginal deliveries-related maternal and neonatal complications. Therefore, this systematic review and meta-analysis aimed to determine the prevalence, indications, and outcomes of operative vaginal deliveries among mothers who gave birth in Ethiopia. Methods A literature search was done through databases such as PubMed, SCOPUS, Web of Sciences, CAB Abstract, and CINHAL (EBSCO) to search studies that have been conducted in Ethiopia. Relevant sources were consulted to retrieve unpublished studies. Original observational studies that reported the prevalence, indication and outcomes of operative vaginal deliveries conducted in the English language were identified and screened. Studies were independently assessed for inclusion, data extraction, and risk of bias. Results Twelve studies were reviewed. The overall pooled prevalence of operative vaginal delivery among mothers who gave birth in Ethiopia was 10% (95% CI: 8 to 13) with I2 = 98.82% and a p-value ≤ 0.001. Fetal distress, prolonged labor, and maternal exhaustion were the most common feto-maternal indications of OVDs whereas; neonatal death, poor Apgar score, admission to neonatal intensive care unit, perianal tear, and postpartum hemorrhage were complications that occur following the operative vaginal deliveries in Ethiopia. Conclusion This systematic review and meta-analysis showed one out of 10 mothers undergo operative vaginal deliveries. Almost all feto-maternal complications that arise following operative vaginal deliveries were preventable. Thus, concerned stakeholders should encourage quality OVDs practice by avoiding unnecessary indications and scaling up the skill of health professionals through special training. Systematic review registration http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022311432.

Project description:ObjectiveIn developing countries like Ethiopia, there is lack of evidence that shows the magnitude and factors affecting complications of instrumental delivery. Most of the research done in Ethiopia was secondary data and lacks variables like socio-demographic factors, availability of cardiotocograph, number of traction, and who conducted delivery (qualification of health workers). So, this study tried to fill the gaps by conducting primary research with secondary data and adding those variables stated above.MethodsHealth facility-based cross-sectional study was conducted from 20 February 20 June 2020 in five public hospitals in East Wollega Zone. Single population proportion formula used to calculate sample size. Systematic random sampling was employed. Interviewer-administered structured questionnaire, checklist, and document review were used to collect data from 282 respondents. Data entered to Epi Data version 3.01 and exported to a statistical package of social sciences version 21 for analysis. Those variables with p < 0.25 in the bivariate analyses were a candidate for multivariable logistic regression and multivariable logistic regression was done to identify factors associated with complications of instrumental vaginal delivery using 95% confidence interval and p < 0.05.ResultsComplications of instrumental vaginal delivery were 37.2%. Out of all neonates delivered by operative vaginal delivery, 69 (24.5%) developed complications. Vacuum-assisted delivery (adjusted odd ratio = 0.245, 95% confidence interval 0.092-0.658), 120-160 fetal heartbeats per minute (adjusted odd ratio = 0.298, 95% confidence interval 0.114-0.628), birthweight > 4000 g (adjusted odd ratio = 4.09, 95% confidence interval 1.729-9.499) and outlet instrumentation (adjusted odd ratio = 0.139, 95% confidence interval 0.057-0.339) were associated with complications of instrumental vaginal delivery.ConclusionMagnitude of complications of instrumental vaginal delivery was high in the study area. So, health professionals should give due attention on instrument selection and application. Instrumental delivery requires a careful assessment of clinical circumstances to identify the indications and contraindications for the application of the instruments.

Project description:ObjectiveTo quantify severe perinatal and maternal morbidity/mortality associated with midcavity operative vaginal delivery compared with caesarean delivery.DesignPopulation-based, retrospective cohort study.SettingBritish Columbia, Canada.PopulationTerm, singleton deliveries (2004-2014) by attempted midcavity operative vaginal delivery or caesarean delivery in the second stage of labour, stratified by indication for operative delivery (n = 10 901 deliveries; 5057 indicated for dystocia, 5844 for fetal distress).MethodsMultinomial propensity scores and mulitvariable log-binomial regression models were used to estimate adjusted rate ratios (ARR) and 95% confidence intervals (95% CI).Main outcome measuresComposite severe perinatal morbidity/mortality (e.g. convulsions, severe birth trauma and perinatal death) and severe maternal morbidity (e.g. severe postpartum haemorrhage, shock, sepsis and cardiac complications).ResultsAmong deliveries with dystocia, attempted midcavity operative vaginal delivery was associated with higher rates of severe perinatal morbidity/mortality compared with caesarean delivery (forceps ARR 2.11, 95% CI 1.46-3.07; vacuum ARR 2.71, 95% CI 1.49-3.15; sequential ARR 4.68, 95% CI 3.33-6.58). Rates of severe maternal morbidity/mortality were also higher following midcavity operative vaginal delivery (forceps ARR 1.57, 95% CI 1.05-2.36; vacuum ARR 2.29, 95% CI 1.57-3.36). Among deliveries with fetal distress, there were significant increases in severe perinatal morbidity/mortality following attempted midcavity vacuum (ARR 1.28, 95% CI 1.04-1.61) and in severe maternal morbidity following attempted midcavity forceps delivery (ARR 2.34, 95% CI 1.54-3.56).ConclusionAttempted midcavity operative vaginal delivery is associated with higher rates of severe perinatal morbidity/mortality and severe maternal morbidity, though these effects differ by indication and instrument.Tweetable abstractPerinatal and maternal morbidity is increased following midcavity operative vaginal delivery.

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Dataset Information

A prospective cohort study of the morbidity associated with operative vaginal deliveries performed by day and at night.

Objective

Design

Setting

Population

Methods

Main outcome measures

Results

Conclusions

Publications

A prospective cohort study of the morbidity associated with operative vaginal deliveries performed by day and at night.

Similar Datasets

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