article · South African Family Practice
In rural district hospitals lacking specialist obstetric support, vacuum-assisted vaginal deliveries offer a safe alternative to second-stage caesarean sections. An evaluation of over seven thousand births examined more than five hundred second-stage interventions, comparing vacuum delivery attempts against caesarean deliveries. Generalist medical staff conducted vacuum deliveries far more rapidly, achieving a decision-to-delivery interval under thirty minutes in seventy-nine per cent of cases compared to twenty-one per cent for caesarean procedures. After adjusting for confounding factors, attempted vacuum deliveries reduced the odds of postpartum haemorrhage by seventy per cent. Rates of composite adverse maternal outcomes and composite adverse perinatal outcomes did not differ significantly between the two methods. These findings demonstrate that generalist medical practitioners can safely provide vacuum-assisted delivery in resource-constrained rural settings without compromising maternal or foetal safety.
Second-stage caesarean deliveries present substantial surgical risks, especially in remote hospitals lacking specialist obstetricians. Demonstrating that generalist doctors can safely perform vacuum-assisted vaginal deliveries provides clinical teams with a faster, less invasive alternative. This reduces severe maternal bleeding while maintaining equivalent newborn outcomes in facilities where access to specialist surgical care is limited.
The abstract does not describe a commercial product, but rather clinical evidence applicable to health services and training programmes. Hospital managers, health authorities, and medical training providers could use these findings to update clinical guidelines and expand procedural simulation training for rural doctors. Because the evidence is applied and tested in an active district hospital, the operational practices are readily translatable to similar healthcare settings without technological development delays.
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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.
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DOI: 10.4102/safp.v68i1.6304
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