Comparative study of maternal and fetal outcome with forceps application versus vacuum extraction in caesarean section

Abstract

Introduction: Instrumental delivery is an art that is fading and may disappear in the near future also increasing safety of section more obstetricians are resorting to caesarean sections leading to increasing trends of section and its complications. Instrumental delivery for floating head during C-section comprise use of vacuum or forceps in selected cases thereby reducing maternal morbidity in terms of blood loss , extension of uterine incision and fetal morbidity by decreasing time taken for incision -delivery interval. Aims: To compare the forceps application with vacuum extraction of fetal head during caesarean section for cases with anticipated or actual difficulty in delivery. Materials and methods: It is a observational prospective study comparing the maternal and fetal outcome with intracaesarean forceps application and vacuum extraction of fetal head during the time period of one year. 100 cases of anticipated or actual difficulty in head delivery during caesarean section, 50 cases of forceps application were compared with vacuum application of 50 cases aided for fetal head delivery, with regard to maternal and fetal outcome, on basis of simple randomisation technique.Results: U-D Interval difference between the two groups(vacuum and forceps) is not statistically significant. Instrument application to delivery interval is shorter in forceps group. More number of cases involving uterine angle and  requiring fundal pressure. The amount of blood loss during caesarean section is significantly higher in forceps group in comparison with vacuum group. The difference in birth weight between two groups is not statistically significant .Apgar score of neonates at one and five minutes of both the groups were similar. 3 cases had Apgar score between 4-7 in forceps group, which is attributable to associated comorbidities, i,e., placenta previa in one case and antepartum eclampsia in other 2 cases. In vacuum group also 3 neonates had apgar scores between 4-7, probably due to comorbidities i.e.,Gestational Hypertension in 3 cases. No obvious injuries were seen in neonates of each groups.Conclusion: The use of vacuum device is a safe and effective technique to assist delivery during caesarean section.  With the rising rate of caesarean section, there is a need for surgeons to expertise in vacuum delivery technique to provide safe and effective delivery of floating head to prevent complication due to dislodgment of head from uterine incision site.