Maternal and perinatal outcomes after vacuum-assisted vaginal delivery versus second-stage caesarean delivery in a generalist-run rural district hospital: A retrospective cohort study

Abstract

Background: Vacuum-assisted vaginal deliveries (VADs) are recommended as safe alternatives to second-stage caesarean deliveries (SSCDs); however, little is known about their use and associated outcomes in South African rural district hospitals without obstetric specialist support.
Methods: A 5-year retrospective cohort study was conducted at a rural district hospital in South Africa. Women who underwent a VAD attempt or SSCD in the second stage of labour were compared with respect to baseline sociodemographic and clinical characteristics, and maternal and perinatal outcomes. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs).
Results: Of 7293 deliveries during the study period, 567 met inclusion criteria, including 417 VAD attempts and 150 SSCDs. Baseline characteristics were largely similar, with SSCDs more frequently performed in women with a previous caesarean delivery, for prolonged second stage of labour, and by community service medical officers. Vacuum-assisted delivery attempts were more commonly used for foetal distress and were associated with significantly shorter decision-to-delivery intervals (< 30 min in 79% vs 21%, p < 0.01). After adjustment, VAD attempts were associated with reduced odds of postpartum haemorrhage (aOR 0.30, 95% confidence interval [CI] 0.15–0.60), with no significant difference in composite adverse maternal outcomes (aOR 0.64, 95% CI 0.39–1.05) or composite adverse perinatal outcomes (aOR 0.82, 95% CI 0.42–1.60).
Conclusion: In this rural district hospital setting, VAD attempts performed by doctors without obstetric specialist support were associated with improved short-term maternal outcomes and equivalent perinatal outcomes compared with SSCDs.
Contribution: These findings support the safe use of VAD in rural settings and highlight the potential contribution of family physicians and family medicine registrars to second-stage obstetric decision-making.