Destructive vaginal deliveries at a teaching hospital in Addis Ababa, Ethiopia.

OBJECTIVES

To assess the incidence, indications and complications of destructive vaginal deliveries.

DESIGN

Retrospective study on the incidence, methods used, and outcomes of destructive vaginal deliveries (DVDs) performed by residents in obstetrics-gynecology from 1997 to 2002.

SETTING

Tikur Anbessa Teaching Hospital, Addis Ababa, Ethiopia.

RESULT: Overall, there were 7.8 DVDs per 1000 deliveries, with an increasing trend during the five years of the study. Craniotomy was the most common (94%) DVD-procedure mainly used for cephalopelvic disproportion (CPD), accounting for 89% of the craniotomies. The proportion of craniotomy to all the DVDs used was significantly more (p-value < 0.05) among non-Addis Ababa residents (98.6%) than among Addis Ababa residents (87.2%). Among the 54 women with known last menstrual date, gestational ages ranged from 31 to 45 weeks with 7.4% 13% and 79.6% of them being post-term, preterm and term, respectively. Labor lasted from 8 to 96 hours. While 104 (88.8%) women had labor-duration of more than 24 hours, 65 (56%) women had duration of more than 12 hours. Fistula was significantly higher (p-value < 0.05) among women with labor of more than 24 hours (15.4%) than those with shorter durations (0%). Similarly, significantly higher difference (p-value < 0.05) was found in infection among labors of more than 24 hours (47.7%) than shorter duration (11.8%). Minor genital traumas were significantly more frequent (p-value < 0.05) among first-time mothers (50.6%) than multiparous (25.8%).

CONCLUSION

The low use of episiotomy (7.8 %) might have contributed to the high rate of minor genital traumas. Compared to birth weight of singleton live births in Ethiopian described by various hospital based studies (Tikur Anbessa (3126 g), Jimma (3183 g) and Sidamo hospital (3243 g)), the average birth weight of the fetuses in the craniotomy group (2957 g) found in this study ivas smaller. This may indicate that, in Ethiopia, the role of small pelvic size in CPD is more important than fetal weight. To alleviate the painful and difficult travel of laboring mothers to major hospitals, training of general practitioners in destructive vaginal delivery, pre- and post procedure care need to be strengthened