Comparision of outcomes of subsequent delivery among previous vacuum and previous second stage cesarean section delivery mothers at Kawempe National Referral Hospital : a retrospective cohort study

Abstract

Introduction: The increasing trends in cesarean section (CS) with a decrease in operative vaginal deliveries is a major concern in health care system all over the world, particularly in low-resource settings. Studies show that a first delivery by CS is associated with an increased risk of repeat CS in the subsequent deliveries. In addition, CS compared to operative vaginal delivery (OVD), attracts higher health service costs yet resource-constrained countries have low rates of OVD compared to high-income countries. Furthermore, OVD is underused in countries where pregnant women continue to face hardships in accessing emergency obstetric care and where cesarean birth is relatively unsafe. The aim of this study was to compare outcomes of the subsequent delivery among previous vacuum and previous second stage cesarean section delivery mothers at Kawempe National Referral Hospital. Methods: This was a retrospective cohort study that involved physical or phone interviews of 81 mothers who had an operative delivery in their index pregnancy at Mulago hospital between November 2014 to July 2015. Maternal and neonatal outcomes in the subsequent delivery were compared among participants who had a previous vacuum extraction with those that previously had a second stage cesarean section using Chi-2 square test and a Fisher’s exact test with a 0.05 level of statistical significance. A multivariate logistic regression was performed to determine association between mode of index delivery and maternal and neonatal outcomes in the subsequent delivery. Results: Higher rates of vaginal delivery were achieved among women who had a vacuum extraction (78.4%) compared to those that had a second stage cesarean section in their index delivery (38.6%), p-value =< 0.001. The risk of neonatal injuries was higher in the group of women with a previous second stage cesarean delivery compared to those with a previous vacuum extraction (11.4% compared to 0%, p value of 0.034). Conclusions and recommendations: Vacuum extraction does not only provide a safe and effective way to prevent the increasing rates of primary cesarean section, but also reduces the risk of repeat cesarean section and the complications associated with it. Health workers need to continue to offer choice of vacuum extraction in the second stage of labor among prime gravidas that fulfill its indication. This will help curb the up-surging rates in cesarean section.