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  • Title: The use of the vacuum extractor in a Nigerian hospital.
    Author: Okpere EE, Itabor AI.
    Journal: Int J Gynaecol Obstet; 1982 Feb; 20(1):29-33. PubMed ID: 6126404.
    Abstract:
    The use of the vacuum extractor over a 5-year period is reviewed. The instrument was used on 319 occasions, with a 2.8% failure rate and a 25 per thousand corrected perinatal mortality. The maternal morbidity attributable to the use of the instrument was low. The main indications for use were to expedite labor either in the first or second stage because of maternal or fetal distress, and in the rotation and subsequent delivery of the malpositioned vertex. It was found to be particularly useful for the platypellic pelvis with an android tendency, a type rather common in Nigerian parturients. The use of the vacuum extractor over the July 1, 1975 through June 30, 1980 period at the University of Benin Teaching Hospital in Nigeria is reviewed. The maternity records of all patients who delivered during that period were examined, and the case notes of all patients and infants who had a vacuum extraction were examined in detail. Areas of interest in the study included the antenatal course, labor and mode of delivery, operative and postoperative complications, perinatal morbidity and mortality, and maternal morbidity and mortality. 13,376 patients delivered at the hospital over this 5 year period. The ventouse was used on 319 occasions (2.4%). There were 9 failures (2.8%). Of the failed extractions, 5 were delivered by forceps and 4 by cesarean sections. Among the 319 mothers, 137 were primiparas and 182 were multiparas. 54 of the sample were grand multiparas. General anesthesia was found necessary in only 5 cases. In 210 cases, pudendal block was used and local infiltration was adequate in 52 cases. No anesthetic was used in 57 cases. In 110 cases (34%), the instrument was applied during the 1st stage of labor. Most applications before full cervical dilatation were for fetal distress and/or maternal distress. There was no maternal mortality. 3 patients had cervical tears, and 6 had vaginal wall lacerations that were easily repaired. There were 14 cases of puerperal phrexia; 6 were a result of urinary tract infections and 8 were from genital sepsis. Episiotomies were performed in 160 cases. 18 patients (5.6%) had primary postpartum hemorrhage; there were 2 cases of retained placenta. Abrasions of the fetal skin about the rim of application site occurred in 13 cases, and these healed readily without visible scar or alopecia. There were 2 cases of cephalohematoma and 2 cases of subaponeurotic hemorrhages. There were 14 perinatal deaths. The correlated perinatal mortality was 25/1000 (8 of 319). Study results show that acceptable fetal results may be obtained by the judicious use of the vacuum extractor.
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