**8. Complications**

While the role of operative vaginal deliveries using instruments like forceps and vacuum extractor has received wide acclaim, complications, sometimes of profound severity have been documented for both mother and child. These undesired outcomes have made operative vaginal delivery an object of great scrutiny by the medical and lay press.


Table 6. Complications observed with instrumental/operative vaginal deliveries in Zaria Nigeria

While a diverse number of complications have been ascribed to these procedures causality has been difficult to establish.

Operative Vaginal Deliveries in Contemporary Obstetric Practice 267

These refer to procedures to deliver a dead fetus in the presence of obstructed labour. The value of a caesarean section in this circumstance is low and the maternal situation may even make any resort to an abdominal operation rather dangerous. Craniotomy could be performed to reduce the diameter of the fetal head to allow vaginal delivery, and transverse lie could be relived by decapitation. Cleidotomy could be performed sometimes to reduce bisacromial diameter when the shoulders of a dead fetus are impacted while evisceration or embryotomy could be performed if the dead fetus is large and or the abdomen is swollen due to an intra-abdominal tumor. Destructive operations are no longer performed in developed countries where the indications for it no longer exists. Even in developing countries most obstetricians shy away from performing the procedure. In Zaria, only 0.1% of

The

Operative vaginal procedures, mainly vacuum extraction and obstetric forceps delivery have a long history but both still have a place in contemporary obstetric practice. In competent hands and with strict adherence to guidelines, the outcomes for the mother and child are excellent. There is great gain in ensuring that these arts are not lost to the modern day obstetrician. On the other hand, procedures like symphysiotomy and destructive operations may still have value in obstetric practice in low income settings. However the evidence for their value need to be laid out clearly and the guidelines for their use

ACOG (1992) Operative vaginal delivery. ACOG Technical Bulletin. Number 152--February

ACOG (1994) Operative vaginal delivery. ACOG Technical Bulletin Number 196-- August 1994 (replaces No. 152, February 1991). *Int J Gynaecol Obstet,* 47, 179-85. Adaji, S. E., Shittu, S. O. & Sule, S. T. (2009) Operative vaginal deliveries in Zaria, Nigeria.

Ameh, C. A. & Weeks, A. D. (2009) The role of instrumental vaginal delivery in low resource

Attilakos, G., Sibanda, T., Winter, C., Johnson, N. & Draycott, T. (2006) A randomised trial of

Bailey, P. E. (2005) The disappearing art of instrumental delivery: Time to reverse the trend.

Baskett, T. F., Fanning, C. A. & Young, D. C. (2008) A prospective observational study of

Chiswick, M. L. & James, D. K. (1979) Kielland's forceps: association with neonatal

*International Journal of Gynecology and Obstetrics,* 91, 89-96.

a new handheld vacuum extraction device. *BJOG: An International Journal of* 

1000 vacuum assisted deliveries with the OmniCup Device. *J Obstet Gynaecol Can*,

*Obstetrics,*

**9.1 Fetal destructive operations** 

**10. Conclusion** 

comprehensively updated.

573 580.

**11. References** 

deliveries were by destructive procedures (Adaji et al., 2009).

1991. *Int J Gynaecol Obstet,* 38, 55-60.

settings. *BJOG,* 116 Suppl 1, 22-5.

*Obstetrics and Gynaecology.,* 113, 494-495.

morbidity and mortality. *BMJ,* 1, 7-9.

*Ann Afr Med,* 8, 95-9.

In the Zaria study, maternal/ fetal complication was found in 22.3% of cases of instrumental delivery. Table 6 above provides details of these complications. The most severe of the complications were the fetal deaths recorded for vacuum deliveries. However the deaths may have been due to the severity of the fetal distress that indicated the procedure rather than the procedure itself.

Newborn intracranial injuries and shoulder dystocia were other complications associated with operative vaginal deliveries from large reviews. Intracranial injuries documented include epidural, subdural and subarachnoid haemorrhages. The fetus could also develop sub-galeal (subaponeurotic) haemorrhage (Doumouchtsis).
