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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2016

Open Access 01-12-2016 | Research article

Audit of a program to increase the use of vacuum extraction in Mulago Hospital, Uganda

Authors: Barbara Nolens, John Lule, Flavia Namiiro, Jos van Roosmalen, Josaphat Byamugisha

Published in: BMC Pregnancy and Childbirth | Issue 1/2016

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Abstract

Background

Prolonged second stage of labour is a major cause of perinatal and maternal morbidity and mortality in low-income countries. Vacuum extraction is a proven effective intervention, hardly used in Africa. Many authors and organisations recommend (re)introduction of vacuum extraction, but successful implementation has not been reported. In 2012, a program to increase the use of vacuum extraction was implemented in Mulago Hospital, Uganda. The program consisted of development of a vacuum extraction guideline, supply of equipment and training of staff. The objective of this study was to investigate the impact of the program.

Methods

Audit of a quality improvement intervention with before and after measurement of outcome parameters. Setting: Mulago Hospital, the national referral hospital for Uganda with approximately 33 000 deliveries per year. It is the university teaching hospital for Makerere University and most of the countries doctors and midwives are trained here. Data was collected from hospital registers and medical files for a period of two years. Main outcome measures were vacuum extraction rate, intrapartum stillbirth, neonatal death, uterine rupture, maternal death and decision to delivery interval.

Results

Mode of delivery and outcome of 12 143 deliveries before and 34 894 deliveries after implementation of the program were analysed. The vacuum extraction rate increased from 0.6 – 2.4 % of deliveries (p < 0.01) and was still rising after 18 months. There was a decline in intrapartum stillbirths from 34 to 26 per 1000 births (-23.6 %, p < 0.01) and women with uterine rupture from 1.1 – 0.8 per 100 births (-25.5 %, p < 0.01). Decision to delivery interval for vacuum extraction was four hours shorter than for caesarean section.

Conclusions

A program to increase the use of vacuum extraction was successful in a high-volume university hospital in sub-Saharan Africa. The use of vacuum extraction increased. An association with improved maternal and perinatal outcome is strongly suggested. We recommend broad implementation of vacuum extraction, whereby university hospitals like Mulago Hospital can play an important role.To support implementation, we recommend further research into outcome of vacuum extraction and into vacuum extraction devices for low-income countries. Such studies are now in progress at Mulago Hospital.
Literature
1.
Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. Global, regional and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:980–1004.CrossRefPubMedPubMedCentral
2.
United Nations Inter-agency Group for Child Mortality Estimation. Levels and trends in child mortality: report 2015. New York: United Nation Children’s Fund; 2015.
3.
Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet. 2016;387:587–603.CrossRefPubMed
4.
5.
Hofmeyr GJ. Obstructed labor: using better technologies to reduce mortality. Int J Gynaecol Obstet. 2004;85 Suppl 1:S62–72.CrossRefPubMed
6.
Tsu VD. Appropriate technology to prevent maternal mortality: current research requirements. BJOG. 2005;112:1213–8.CrossRefPubMed
7.
Mbaruku G, van Roosmalen J, Kimondo I, Bilango F, Bergstrom S. Perinatal audit using the 3-delays model in western Tanzania. Int J Gynaecol Obstet. 2009;106:85–8.CrossRefPubMed
8.
Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 154: Operative Vaginal Delivery. Obstet Gynaecol. 2015;126(5):e56–65.
9.
10.
World Health Organization. Integrated Management of Pregnancy and Childbirth: Managing complications in pregnancy and childbirth: A guide for midwives and doctors. Geneva: WHO; 2000. reprint 2007.
11.
Ministry of Health, Uganda. Uganda safe motherhood life saving skills trainin. In: Trainees’ handbook. The Republic of Uganda: Reproductive Health Division, MOH; 2012.
12.
Villar J, Carroli G, Zavaleta N, Donner A, Wojdyla D, Faundes A, et al. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ. 2007;335:1025.CrossRefPubMedPubMedCentral
13.
Murphy DJ, Liebling RE, Verity L, Swingler R, Patel R. Early maternal and neonatal morbidity associated with operative delivery in second stage of labour: a cohort study. Lancet. 2001;358:1203–07.CrossRefPubMed
14.
Souza JP, Gulmezoglu AM, Lumbiganon P, Laopaiboon M, Carroli G, Fawole B, et al. Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health. BMC Med. 2010;8:71.CrossRefPubMedPubMedCentral
15.
Towner D, Castro MA, Eby-Wilkens E, Gilbert WM. Effect of mode of delivery in nulliparous women on neonatal intracranial injury. N Engl J Med. 1999;341:1709–14.CrossRefPubMed
16.
Macfarlane AJ, Blondel B, Mohangoo AD, Cuttini M, Nijhuis J, Novak Z et al. Wide differences in mode of delivery within Europe: risk-stratified analyses of aggregated routine data from the Euro-Peristat study. BJOG 2015; doi:10.​1111/​1471-0528.​13284.
17.
18.
19.
20.
Ameh CA, Weeks AD. The role of instrumental vaginal delivery in low resource settings. BJOG. 2009;116 Suppl 1:22–5.CrossRefPubMed
21.
Bailey PE. The disappearing art of instrumental delivery: Time to reverse the trend. Int J Gynaecol Obstet. 2005;91:89–96.CrossRefPubMed
22.
Nkwabong E, Nana PN, Mbu R, Takang W, Ekono MR, Kouam L. Indications and maternofetal outcome of instrumental deliveries at the University Teaching Hospital of Yaounde, Cameroon. Trop Doc. 2011;41:5–7.CrossRef
23.
Wanyonyi SZ, Achila B, Gudu N. Factors contributing to failure of vacuum delivery and associated maternal/neonatal morbidity. Int J Gynaecol Obstet. 2011;115:157–60.CrossRefPubMed
24.
Maaløe N, Sorensen BL, Onesmo R, Secher NJ, Bygbjerg IC. Prolonged labour as indication for emergency caesarean section: a quality assurance analysis by criterion-based audit at two Tanzanian rural hospitals. BJOG. 2012;119:605–13.CrossRefPubMed
25.
Van Roosmalen J. Perinatal mortality in rural Tanzania. BJOG. 1989;96:827–34.CrossRef
26.
27.
Adaji SE, Shittu SO, Sule ST. Operative vaginal deliveries in Zaria, Nigeria. Ann Afr Med. 2009;8(2):95–9.
28.
Fauveau V. Is vacuum extraction still known, taught and practiced? A worldwide KAP survey. Int J Gynaecol Obstet. 2006;94:185–9.CrossRefPubMed
29.
Souza JP, Widmer M, Gülmezoglu AM, Lawrie TA, Adejuyigbe EA, Carroli G, et al. Maternal and perinatal health research priorities beyond 2015; an international survey and prioritization exercise. Reprod Health. 2014;11:61.CrossRefPubMedPubMedCentral
30.
Maaløe N, Bygbjerg IC, Onesmo R, Secher NJ, Sorensen BL. Disclosing doubtful indications for emergency cesarean sections in rural hospitals in Tanzania: a retrospective criterion-based audit. Acta Obstet Gynecol Scand. 2012;91:1069–76.CrossRefPubMed
31.
32.
33.
34.
Van den Akker T, Beatrice M, James I, van Roosmalen J. Using audits to reduce the incidence of uterine rupture in a Malawian district hospital. Int J Gynaecol Obstet. 2009;107(3):289–94.CrossRefPubMed
35.
Mukasa PK, Kabakyenga J, Senkungu JK, Ngonzi J, Kyalimpa M, van Roosmalen JJ. Uterine rupture in a teaching hospital in Mbarara, western Uganda, unmatched case- control study. Reprod Health. 2013;10:29.CrossRefPubMedPubMedCentral
36.
Hofmeyr GJ, Say L, Gülmezoglu AM. WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture. BJOG. 2005;112(9):1221–8.CrossRefPubMed
37.
O’Mahony F, Hofmeyr GJ, Menon V. Choice of instruments for assisted vaginal delivery. Cochrane Database Syst Rev. 2010;11:CD005455.
38.
Attilakos G, Sibanda T, Winter C, Johnson N, Draycott T. A randomised controlled trial of a new handheld vacuum extraction device. BJOG. 2005;112:1510–5.CrossRefPubMed
39.
Groom KM, Jones BA, Miller N, Paterson-Brown S. A prospective randomised controlled trial of the Kiwi Omnicup versus conventional ventouse cups for vacuum-assisted vaginal delivery. BJOG. 2006;113:183–9.CrossRefPubMed
Metadata
Title
Audit of a program to increase the use of vacuum extraction in Mulago Hospital, Uganda
Authors
Barbara Nolens
John Lule
Flavia Namiiro
Jos van Roosmalen
Josaphat Byamugisha
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2016
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-016-1052-3

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