Fetomaternal Outcomes between Instrumental Vaginal Delivery and Caesarean Section in Second Stage of Labour: A Prospective Interventional Study

Abstract

Introduction: Rates of caesarean section deliveries are increasing worldwide including India. The reasons for this increasing trend are many. Caesarean section being a major operative procedure is associated with various complications. Instrumental vaginal delivery has the advantage of reducing these complications associated with caesarean delivery. As of today, there is no clear consensus regarding the safest and most effective mode of intervention in second stage of labour. Aim: To compare foetal and maternal outcomes between instrumental vaginal delivery and caesarean section in second stage of labour. Materials and Methods: It was a hospital-based prospective interventional study, conducted over a period of 18 months. A total of 104 mothers with live, singleton, term foetuses in vertex presentation who required intervention in second stage of labour were included in the study. The entire study population was divided into two groups depending on the type of intervention used in second stage- instrumental vaginal delivery (n=52) and caesarean section (n=52). Maternal outcomes of Postpartum Haemorrhage (PPH), perineal lacerations, febrile illness, blood transfusion and wound infection were compared using Chi-square test. Neonatal outcomes like birth weight, need for resuscitation, Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score, neonatal jaundice, sepsis and mortality were compared using Chi-square test and t-test. Results: Females undergoing caesarean section had more atonic PPH (5.8%), need for blood transfusion (19.2%), postpartum wound infection (17.3%) and febrile illness (26.9%, p=0.010). Third and fourth degree perineal lacerations were more common in the instrumental delivery group (19.2%, p=0.001). Mean weight of babies born by caesarean section (3127 g) was higher than those by instrumental delivery (2962 g). Composite neonatal outcome was not significantly different in both groups. Conclusion: Caesarean section in second stage of labour leads to increased maternal morbidity as compared to instrumental vaginal delivery. In skilled hands, these instruments can aid in smooth delivery of a healthy baby and can avoid the risks associated with second stage caesarean section.

Keywords

• forceps
• operative vaginal delivery
• perineal lacerations
• ventouse