Frequency of second stage intervention and its outcome in relation with instrumental vaginal delivery versus caesarean section.

BACKGROUND

To determine the frequency of second stage intervention and the risk of maternal and foetal morbidity and mortality associated with instrumental vaginal deliveries versus caesarean section in our tertiary care set up.

METHODS

This descriptive study was conducted in the Department of Obstetrics and Gynaecology (Unit-II) Liaquat University Hospital Hyderabad Sindh, Pakistan from January 2005 to December 2006. All the women who underwent instrumental vaginal delivery and caesarean section due to prolonged second stage of labour were included in this study. Data were collected on a pre-designed proforma, which included demographic details, maternal and perinatal morbidity as well as any complications etc. Finally, data were analysed through software program SPSS 10.0.

RESULTS

Frequency of second stage intervention was 22.2%. Among, 400 women who undergone second stage intervention, 240 (60%) were delivered by caesarean section and 160 (40%) were delivered with the help of instruments. Majority of women, i.e., 49.25% were between 21-30 years of age, 73% were un-booked cases while 45% cases were primigravida. Complications with abdominal delivery were paralytic ileus in 35 (14.58%) cases, post partum haemorrhage in 30 (12.5%) cases and tear extension in 13 cases. Complications with instrumental delivery were vaginal tear in 28 (17.5%) cases, cervical tear in 12 (7.5%) and third degree perineal tear in 4 (2.5%) cases. The perinatal outcome with abdominal delivery (86.66%) was better as compared to instrumental delivery (72.5%).

CONCLUSION

The frequency of second stage intervention seems high in our set up and is associated with significant maternal and perinatal morbidity. Maternal morbidity was more frequent abdominal delivery while neonatal morbidity and mortality was more frequent with instrumental delivery.