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Josaphat Byamugisha - One of the best experts on this subject based on the ideXlab platform.
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Health Workers’perspectives on Vacuum Extraction in Mulago Hospital, Uganda
2020Co-Authors: Manuela Capelle, Barbara Nolens, John Lule, Josaphat Byamugisha, Jos Van Roosmalen, Thomas Van Den AkkerAbstract:Abstract Background: The objective of this manuscript is toexplore perceptions of health workersregardingthe use of Vacuum Extraction, two years after the implementation of training programme, in Mulago Hospital, Uganda. Methods: A cross-sectional survey among midwives, residents and consultant obstetricians,was performed. It was composed of questions pertaining to Vacuum Extraction, addressing reasons for low use, recommendations to increase use, preferred mode of birth, views aboutwho is suited to perform the procedure and contraindications.Results: Eighty-threeof 134(61.9%) participants returned the survey. The most frequent reasons for low use of Vacuum Extraction were lack of training (60/83, 72.3%) andequipment (59/83, 71.1%). Skills training and improved supply of equipment were recommended. Most participants (57/83, 68.8%) chose Vacuum Extraction over caesarean section as hypothetical mode of birth forthemselves or a relative. There was a tendency to cite contraindications not identified as such in international guidelines (big baby, caput succedaneum, moulding). Midwives and doctors with appropriate training were generally allconsideredsuited to perform Vacuum Extraction. Conclusion: Health workers generally conveyed a positive attitude towards Vacuum Extraction, despite some perceived barriers, often unsupported by evidence.Organisation of skills training, supply of equipment and focus on knowledge of indications are essential to increase its use.
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Women's recommendations: Vacuum Extraction or caesarean section for prolonged second stage of labour, a prospective cohort study in Uganda.
Tropical medicine & international health : TM & IH, 2019Co-Authors: Barbara Nolens, John Lule, Jos Van Roosmalen, Thomas Van Den Akker, Sulphine Twinomuhangi, Josaphat ByamugishaAbstract:Objectives: To investigate what women who have experienced Vacuum Extraction or second stage caesarean section (CS) would recommend as mode of birth in case of prolonged second stage of labour. Methods: A prospective cohort study was conducted in a tertiary referral hospital in Uganda. Between November 2014 and July 2015, women with a term singleton in vertex presentation who had undergone Vacuum Extraction or second stage CS were included. The first day and 6 months after birth women were asked what they would recommend to a friend: Vacuum Extraction or CS and why. Outcome measures were: proportions of women choosing Vacuum Extraction vs. CS and reasons for choosing this mode of birth. Results: The first day after birth, 293/318 (92.1%) women who had undergone Vacuum Extraction and 176/409 (43.0%) women who had undergone CS recommended Vacuum Extraction. Of women who had given birth by CS in a previous pregnancy and had Vacuum Extraction this time, 31/32 (96.9%) recommended Vacuum Extraction. Six months after birth findings were comparable. Less pain, shorter recovery period, avoiding surgery and the presumed relative safety of Vacuum Extraction to the mother were the main reasons for preferring Vacuum Extraction. Main reasons to opt for CS were having experienced CS without problems, CS presumed as being safer for the neonate, CS being the only option the woman was aware of, as well as the concern that Vacuum Extraction would fail. Conclusions: Most women would recommend Vacuum Extraction over CS in case of prolonged second stage of labour.
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prospective cohort study comparing outcomes between Vacuum Extraction and second stage cesarean delivery at a ugandan tertiary referral hospital
International Journal of Gynecology & Obstetrics, 2018Co-Authors: Barbara Nolens, John Lule, Jos Van Roosmalen, Thomas Van Den Akker, Flavia Namiiro, Josaphat ByamugishaAbstract:Objective: To compare maternal and perinatal outcomes between Vacuum Extraction and second-stage cesarean delivery (SSCD). Methods: The present observational cohort study was conducted among women with term vertex singleton pregnancies who underwent Vacuum Extraction or SSCD at Mulago National Referral Hospital, Kampala, Uganda, between November 25, 2014, and July 8, 2015. Severe maternal outcomes (mortality, uterine rupture, hysterectomy, re-laparotomy) and perinatal outcomes (mortality, trauma, low Apgar score, convulsions) were compared between initial delivery mode. Results: Among 13 152 deliveries, 358 women who underwent Vacuum Extraction and 425 women who underwent SSCD were enrolled in the study. No maternal deaths occurred after Vacuum Extraction versus five deaths from complications of SSCD. Vacuum Extraction was associated with less severe maternal outcomes compared with SSCD (3 [0.8%] vs 18 [4.2%]; adjusted odds ratio [aOR] 0.24, 95% confidence interval [CI] 0.07–0.84). Fetal death during the decision-to-delivery interval was also less common in the Vacuum Extraction group (3 [0.9%] vs 18 [4.4%]; aOR 0.24, 95% CI 0.07–0.84); however, the perinatal mortality rate did not differ between the Vacuum Extraction and SSCD groups (29 [8.4%] vs 45 [11.0%], respectively; aOR 0.83, 95% CI 0.49–1.41). One infant in each group exhibited neurodevelopmental anomalies at 6 months. Conclusion: Vacuum Extraction had better maternal outcomes and equivalent perinatal outcomes compared with SSCD. These findings encourage re-introduction of Vacuum Extraction.
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audit of a program to increase the use of Vacuum Extraction in mulago hospital uganda
BMC Pregnancy and Childbirth, 2016Co-Authors: Barbara Nolens, John Lule, Jos Van Roosmalen, Flavia Namiiro, Josaphat ByamugishaAbstract:Prolonged second stage of labour is a major cause of perinatal and maternal morbidity and mortality in low-income countries. Vacuum Extraction is a proven effective intervention, hardly used in Africa. Many authors and organisations recommend (re)introduction of Vacuum Extraction, but successful implementation has not been reported. In 2012, a program to increase the use of Vacuum Extraction was implemented in Mulago Hospital, Uganda. The program consisted of development of a Vacuum Extraction guideline, supply of equipment and training of staff. The objective of this study was to investigate the impact of the program. Audit of a quality improvement intervention with before and after measurement of outcome parameters. Setting: Mulago Hospital, the national referral hospital for Uganda with approximately 33 000 deliveries per year. It is the university teaching hospital for Makerere University and most of the countries doctors and midwives are trained here. Data was collected from hospital registers and medical files for a period of two years. Main outcome measures were Vacuum Extraction rate, intrapartum stillbirth, neonatal death, uterine rupture, maternal death and decision to delivery interval. Mode of delivery and outcome of 12 143 deliveries before and 34 894 deliveries after implementation of the program were analysed. The Vacuum Extraction rate increased from 0.6 – 2.4 % of deliveries (p < 0.01) and was still rising after 18 months. There was a decline in intrapartum stillbirths from 34 to 26 per 1000 births (-23.6 %, p < 0.01) and women with uterine rupture from 1.1 – 0.8 per 100 births (-25.5 %, p < 0.01). Decision to delivery interval for Vacuum Extraction was four hours shorter than for caesarean section. A program to increase the use of Vacuum Extraction was successful in a high-volume university hospital in sub-Saharan Africa. The use of Vacuum Extraction increased. An association with improved maternal and perinatal outcome is strongly suggested. We recommend broad implementation of Vacuum Extraction, whereby university hospitals like Mulago Hospital can play an important role.To support implementation, we recommend further research into outcome of Vacuum Extraction and into Vacuum Extraction devices for low-income countries. Such studies are now in progress at Mulago Hospital.
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Audit of a program to increase the use of Vacuum Extraction in Mulago Hospital, Uganda
BMC pregnancy and childbirth, 2016Co-Authors: Barbara Nolens, John Lule, Jos Van Roosmalen, Flavia Namiiro, Josaphat ByamugishaAbstract:Prolonged second stage of labour is a major cause of perinatal and maternal morbidity and mortality in low-income countries. Vacuum Extraction is a proven effective intervention, hardly used in Africa. Many authors and organisations recommend (re)introduction of Vacuum Extraction, but successful implementation has not been reported. In 2012, a program to increase the use of Vacuum Extraction was implemented in Mulago Hospital, Uganda. The program consisted of development of a Vacuum Extraction guideline, supply of equipment and training of staff. The objective of this study was to investigate the impact of the program. Audit of a quality improvement intervention with before and after measurement of outcome parameters. Setting: Mulago Hospital, the national referral hospital for Uganda with approximately 33 000 deliveries per year. It is the university teaching hospital for Makerere University and most of the countries doctors and midwives are trained here. Data was collected from hospital registers and medical files for a period of two years. Main outcome measures were Vacuum Extraction rate, intrapartum stillbirth, neonatal death, uterine rupture, maternal death and decision to delivery interval. Mode of delivery and outcome of 12 143 deliveries before and 34 894 deliveries after implementation of the program were analysed. The Vacuum Extraction rate increased from 0.6 – 2.4 % of deliveries (p
Rohana Jaafar - One of the best experts on this subject based on the ideXlab platform.
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risk factors associated with subaponeurotic haemorrhage in full term infants exposed to Vacuum Extraction
British Journal of Obstetrics and Gynaecology, 2005Co-Authors: Nemyun Boo, Kin Wai Foong, Zaleha Abdullah Mahdy, Sin Chuen Yong, Rohana JaafarAbstract:Objectives To determine obstetric and neonatal risk factors associated with subaponeurotic haemorrhage (SAH) in infants exposed to Vacuum Extraction. Design A prospective observational study. Setting In the labour room, operation theatre, postnatal wards and neonatal intensive care unit (NICU) of a tertiary teaching hospital. Population All infants born in the hospital with a history of exposure to Vacuum Extraction. Methods A prospective observational study carried out over a 26-month period. All eligible infants were examined at birth and during the first 24 hours of life. Main outcome measures A diagnosis of SAH was based on detection of a tender fluctuant scalp swelling that crossed the skull suture lines of infants. Results Of 10,066 infants born in the hospital during the study period, 338 (3.4%) had exposure to Vacuum Extraction. SAH was detected in 71 (21.0%) of them. Forward multivariate logistic regression analysis showed that five factors were significantly associated with development of SAH: maternal nulliparity (adjusted odds ratio [OR]: 4.0; 95% confidence intervals [CI]: 1.6, 10.0), failed Vacuum Extraction (adjusted OR: 16.4; 95% CI: 2.0, 135.6), Apgar score of less than 8 at 5 minutes of life (adjusted OR: 5.0; 95% CI: 1.7, 15.2), marks of Vacuum cup over the sagittal suture (adjusted OR: 4.4; 95% CI: 1.9, 10.2) and marks of leading edge of Vacuum cup at <3 cm away from the anterior fontanel of infants' heads (adjusted OR: 6.0; 95% CI: 1.7, 21.0). Conclusion Maternal nulliparity, placement of Vacuum Extraction cup over the sagittal suture at a distance too close to infant's anterior fontanel and failed Vacuum Extraction predisposed infants to develop SAH.
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Risk factors associated with subaponeurotic haemorrhage in full-term infants exposed to Vacuum Extraction.
BJOG : an international journal of obstetrics and gynaecology, 2005Co-Authors: Nemyun Boo, Kin Wai Foong, Zaleha Abdullah Mahdy, Sin Chuen Yong, Rohana JaafarAbstract:Objectives To determine obstetric and neonatal risk factors associated with subaponeurotic haemorrhage (SAH) in infants exposed to Vacuum Extraction. Design A prospective observational study. Setting In the labour room, operation theatre, postnatal wards and neonatal intensive care unit (NICU) of a tertiary teaching hospital. Population All infants born in the hospital with a history of exposure to Vacuum Extraction. Methods A prospective observational study carried out over a 26-month period. All eligible infants were examined at birth and during the first 24 hours of life. Main outcome measures A diagnosis of SAH was based on detection of a tender fluctuant scalp swelling that crossed the skull suture lines of infants. Results Of 10,066 infants born in the hospital during the study period, 338 (3.4%) had exposure to Vacuum Extraction. SAH was detected in 71 (21.0%) of them. Forward multivariate logistic regression analysis showed that five factors were significantly associated with development of SAH: maternal nulliparity (adjusted odds ratio [OR]: 4.0; 95% confidence intervals [CI]: 1.6, 10.0), failed Vacuum Extraction (adjusted OR: 16.4; 95% CI: 2.0, 135.6), Apgar score of less than 8 at 5 minutes of life (adjusted OR: 5.0; 95% CI: 1.7, 15.2), marks of Vacuum cup over the sagittal suture (adjusted OR: 4.4; 95% CI: 1.9, 10.2) and marks of leading edge of Vacuum cup at
Jos Van Roosmalen - One of the best experts on this subject based on the ideXlab platform.
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Health Workers’perspectives on Vacuum Extraction in Mulago Hospital, Uganda
2020Co-Authors: Manuela Capelle, Barbara Nolens, John Lule, Josaphat Byamugisha, Jos Van Roosmalen, Thomas Van Den AkkerAbstract:Abstract Background: The objective of this manuscript is toexplore perceptions of health workersregardingthe use of Vacuum Extraction, two years after the implementation of training programme, in Mulago Hospital, Uganda. Methods: A cross-sectional survey among midwives, residents and consultant obstetricians,was performed. It was composed of questions pertaining to Vacuum Extraction, addressing reasons for low use, recommendations to increase use, preferred mode of birth, views aboutwho is suited to perform the procedure and contraindications.Results: Eighty-threeof 134(61.9%) participants returned the survey. The most frequent reasons for low use of Vacuum Extraction were lack of training (60/83, 72.3%) andequipment (59/83, 71.1%). Skills training and improved supply of equipment were recommended. Most participants (57/83, 68.8%) chose Vacuum Extraction over caesarean section as hypothetical mode of birth forthemselves or a relative. There was a tendency to cite contraindications not identified as such in international guidelines (big baby, caput succedaneum, moulding). Midwives and doctors with appropriate training were generally allconsideredsuited to perform Vacuum Extraction. Conclusion: Health workers generally conveyed a positive attitude towards Vacuum Extraction, despite some perceived barriers, often unsupported by evidence.Organisation of skills training, supply of equipment and focus on knowledge of indications are essential to increase its use.
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Women's recommendations: Vacuum Extraction or caesarean section for prolonged second stage of labour, a prospective cohort study in Uganda.
Tropical medicine & international health : TM & IH, 2019Co-Authors: Barbara Nolens, John Lule, Jos Van Roosmalen, Thomas Van Den Akker, Sulphine Twinomuhangi, Josaphat ByamugishaAbstract:Objectives: To investigate what women who have experienced Vacuum Extraction or second stage caesarean section (CS) would recommend as mode of birth in case of prolonged second stage of labour. Methods: A prospective cohort study was conducted in a tertiary referral hospital in Uganda. Between November 2014 and July 2015, women with a term singleton in vertex presentation who had undergone Vacuum Extraction or second stage CS were included. The first day and 6 months after birth women were asked what they would recommend to a friend: Vacuum Extraction or CS and why. Outcome measures were: proportions of women choosing Vacuum Extraction vs. CS and reasons for choosing this mode of birth. Results: The first day after birth, 293/318 (92.1%) women who had undergone Vacuum Extraction and 176/409 (43.0%) women who had undergone CS recommended Vacuum Extraction. Of women who had given birth by CS in a previous pregnancy and had Vacuum Extraction this time, 31/32 (96.9%) recommended Vacuum Extraction. Six months after birth findings were comparable. Less pain, shorter recovery period, avoiding surgery and the presumed relative safety of Vacuum Extraction to the mother were the main reasons for preferring Vacuum Extraction. Main reasons to opt for CS were having experienced CS without problems, CS presumed as being safer for the neonate, CS being the only option the woman was aware of, as well as the concern that Vacuum Extraction would fail. Conclusions: Most women would recommend Vacuum Extraction over CS in case of prolonged second stage of labour.
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prospective cohort study comparing outcomes between Vacuum Extraction and second stage cesarean delivery at a ugandan tertiary referral hospital
International Journal of Gynecology & Obstetrics, 2018Co-Authors: Barbara Nolens, John Lule, Jos Van Roosmalen, Thomas Van Den Akker, Flavia Namiiro, Josaphat ByamugishaAbstract:Objective: To compare maternal and perinatal outcomes between Vacuum Extraction and second-stage cesarean delivery (SSCD). Methods: The present observational cohort study was conducted among women with term vertex singleton pregnancies who underwent Vacuum Extraction or SSCD at Mulago National Referral Hospital, Kampala, Uganda, between November 25, 2014, and July 8, 2015. Severe maternal outcomes (mortality, uterine rupture, hysterectomy, re-laparotomy) and perinatal outcomes (mortality, trauma, low Apgar score, convulsions) were compared between initial delivery mode. Results: Among 13 152 deliveries, 358 women who underwent Vacuum Extraction and 425 women who underwent SSCD were enrolled in the study. No maternal deaths occurred after Vacuum Extraction versus five deaths from complications of SSCD. Vacuum Extraction was associated with less severe maternal outcomes compared with SSCD (3 [0.8%] vs 18 [4.2%]; adjusted odds ratio [aOR] 0.24, 95% confidence interval [CI] 0.07–0.84). Fetal death during the decision-to-delivery interval was also less common in the Vacuum Extraction group (3 [0.9%] vs 18 [4.4%]; aOR 0.24, 95% CI 0.07–0.84); however, the perinatal mortality rate did not differ between the Vacuum Extraction and SSCD groups (29 [8.4%] vs 45 [11.0%], respectively; aOR 0.83, 95% CI 0.49–1.41). One infant in each group exhibited neurodevelopmental anomalies at 6 months. Conclusion: Vacuum Extraction had better maternal outcomes and equivalent perinatal outcomes compared with SSCD. These findings encourage re-introduction of Vacuum Extraction.
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Reintroducing Vacuum Extraction in primary health care facilities: a case study from Tanzania.
BMC pregnancy and childbirth, 2018Co-Authors: Sunday Dominico, Patricia E. Bailey, Nguke Mwakatundu, Mkambu Kasanga, Jos Van RoosmalenAbstract:In rural Tanzania access to emergency obstetric and newborn care is threatened by poor roads and understaffed facilities among other challenges. Districts in Kigoma, Pwani and Morogoro regions were targeted by a local non-governmental organization to assist local government to build capacity and improve access to clinical management of severe obstetric and newborn complications. The program upgraded ten primary health care centres to provide comprehensive emergency obstetric and newborn care. This paper describes the process of reintroducing Vacuum Extraction into ten health centres and five hospitals, highlighting patterns in uptake, mode of delivery and lessons learned. This observational study uses facility-based trend data collected between 2011 and 2016.Descriptive outcomes include institutional caesarean delivery rates, Vacuum Extraction rates, and the ratio of caesareans to Vacuum-assisted deliveries. Institutional caesarean delivery rates remained stable at about 10–11% and the Vacuum Extraction rate rose from virtually no procedures in 2011 to about 2% in 2016. The increase was more visible in upgraded health centres than in hospitals. In 2016 Vacuum Extraction rates in newly upgraded health centres ranged from 0.5 to 7.8%. Between 2011 and 2016, the ratio of caesareans to Vacuum Extractions in hospitals changed from 304 caesareans to 1 Vacuum Extraction to 10:1, while in health centres the ratio changed from 22: 1 to 3: 1. Reintroduction of Vacuum Extraction into clinical practice in primary health care facilities with task-shifting is feasible. Reintroduction of this procedure was more successful when part of an integrated upgrading of health centres to provide comprehensive emergency obstetric care than when reintroduced into busy hospital environments. Turnover of trained staff in hospitals contributed to the uneven uptake of Vacuum Extraction. Lessons learned are applicable to further national scale up and to other countries.
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audit of a program to increase the use of Vacuum Extraction in mulago hospital uganda
BMC Pregnancy and Childbirth, 2016Co-Authors: Barbara Nolens, John Lule, Jos Van Roosmalen, Flavia Namiiro, Josaphat ByamugishaAbstract:Prolonged second stage of labour is a major cause of perinatal and maternal morbidity and mortality in low-income countries. Vacuum Extraction is a proven effective intervention, hardly used in Africa. Many authors and organisations recommend (re)introduction of Vacuum Extraction, but successful implementation has not been reported. In 2012, a program to increase the use of Vacuum Extraction was implemented in Mulago Hospital, Uganda. The program consisted of development of a Vacuum Extraction guideline, supply of equipment and training of staff. The objective of this study was to investigate the impact of the program. Audit of a quality improvement intervention with before and after measurement of outcome parameters. Setting: Mulago Hospital, the national referral hospital for Uganda with approximately 33 000 deliveries per year. It is the university teaching hospital for Makerere University and most of the countries doctors and midwives are trained here. Data was collected from hospital registers and medical files for a period of two years. Main outcome measures were Vacuum Extraction rate, intrapartum stillbirth, neonatal death, uterine rupture, maternal death and decision to delivery interval. Mode of delivery and outcome of 12 143 deliveries before and 34 894 deliveries after implementation of the program were analysed. The Vacuum Extraction rate increased from 0.6 – 2.4 % of deliveries (p < 0.01) and was still rising after 18 months. There was a decline in intrapartum stillbirths from 34 to 26 per 1000 births (-23.6 %, p < 0.01) and women with uterine rupture from 1.1 – 0.8 per 100 births (-25.5 %, p < 0.01). Decision to delivery interval for Vacuum Extraction was four hours shorter than for caesarean section. A program to increase the use of Vacuum Extraction was successful in a high-volume university hospital in sub-Saharan Africa. The use of Vacuum Extraction increased. An association with improved maternal and perinatal outcome is strongly suggested. We recommend broad implementation of Vacuum Extraction, whereby university hospitals like Mulago Hospital can play an important role.To support implementation, we recommend further research into outcome of Vacuum Extraction and into Vacuum Extraction devices for low-income countries. Such studies are now in progress at Mulago Hospital.
Thomas Van Den Akker - One of the best experts on this subject based on the ideXlab platform.
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Health Workers’perspectives on Vacuum Extraction in Mulago Hospital, Uganda
2020Co-Authors: Manuela Capelle, Barbara Nolens, John Lule, Josaphat Byamugisha, Jos Van Roosmalen, Thomas Van Den AkkerAbstract:Abstract Background: The objective of this manuscript is toexplore perceptions of health workersregardingthe use of Vacuum Extraction, two years after the implementation of training programme, in Mulago Hospital, Uganda. Methods: A cross-sectional survey among midwives, residents and consultant obstetricians,was performed. It was composed of questions pertaining to Vacuum Extraction, addressing reasons for low use, recommendations to increase use, preferred mode of birth, views aboutwho is suited to perform the procedure and contraindications.Results: Eighty-threeof 134(61.9%) participants returned the survey. The most frequent reasons for low use of Vacuum Extraction were lack of training (60/83, 72.3%) andequipment (59/83, 71.1%). Skills training and improved supply of equipment were recommended. Most participants (57/83, 68.8%) chose Vacuum Extraction over caesarean section as hypothetical mode of birth forthemselves or a relative. There was a tendency to cite contraindications not identified as such in international guidelines (big baby, caput succedaneum, moulding). Midwives and doctors with appropriate training were generally allconsideredsuited to perform Vacuum Extraction. Conclusion: Health workers generally conveyed a positive attitude towards Vacuum Extraction, despite some perceived barriers, often unsupported by evidence.Organisation of skills training, supply of equipment and focus on knowledge of indications are essential to increase its use.
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Women's recommendations: Vacuum Extraction or caesarean section for prolonged second stage of labour, a prospective cohort study in Uganda.
Tropical medicine & international health : TM & IH, 2019Co-Authors: Barbara Nolens, John Lule, Jos Van Roosmalen, Thomas Van Den Akker, Sulphine Twinomuhangi, Josaphat ByamugishaAbstract:Objectives: To investigate what women who have experienced Vacuum Extraction or second stage caesarean section (CS) would recommend as mode of birth in case of prolonged second stage of labour. Methods: A prospective cohort study was conducted in a tertiary referral hospital in Uganda. Between November 2014 and July 2015, women with a term singleton in vertex presentation who had undergone Vacuum Extraction or second stage CS were included. The first day and 6 months after birth women were asked what they would recommend to a friend: Vacuum Extraction or CS and why. Outcome measures were: proportions of women choosing Vacuum Extraction vs. CS and reasons for choosing this mode of birth. Results: The first day after birth, 293/318 (92.1%) women who had undergone Vacuum Extraction and 176/409 (43.0%) women who had undergone CS recommended Vacuum Extraction. Of women who had given birth by CS in a previous pregnancy and had Vacuum Extraction this time, 31/32 (96.9%) recommended Vacuum Extraction. Six months after birth findings were comparable. Less pain, shorter recovery period, avoiding surgery and the presumed relative safety of Vacuum Extraction to the mother were the main reasons for preferring Vacuum Extraction. Main reasons to opt for CS were having experienced CS without problems, CS presumed as being safer for the neonate, CS being the only option the woman was aware of, as well as the concern that Vacuum Extraction would fail. Conclusions: Most women would recommend Vacuum Extraction over CS in case of prolonged second stage of labour.
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Vacuum Extraction for non-rotational and rotational assisted vaginal birth.
Best practice & research. Clinical obstetrics & gynaecology, 2018Co-Authors: Thomas Van Den AkkerAbstract:Vacuum-assisted birth is a safe mode of birth in the presence of a skilled provider. Vacuum Extraction can avoid prolonged second stage of labour, birth asphyxia in the presence of foetal distress or maternal pushing where contraindicated. Vacuum-assisted births - particularly those in midpelvic rotational births - have been increasingly traded for caesarean births, although the latter are generally associated with potentially a greater risk to women and (future) children. In this article, (contra)indications and the basics of Vacuum technique are elaborated. A specific section is dedicated to Vacuum Extraction for rotational birth. If these techniques are known, trained and practiced by obstetric care givers, then Vacuum Extraction has tremendous potential to make childbirth safer.
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prospective cohort study comparing outcomes between Vacuum Extraction and second stage cesarean delivery at a ugandan tertiary referral hospital
International Journal of Gynecology & Obstetrics, 2018Co-Authors: Barbara Nolens, John Lule, Jos Van Roosmalen, Thomas Van Den Akker, Flavia Namiiro, Josaphat ByamugishaAbstract:Objective: To compare maternal and perinatal outcomes between Vacuum Extraction and second-stage cesarean delivery (SSCD). Methods: The present observational cohort study was conducted among women with term vertex singleton pregnancies who underwent Vacuum Extraction or SSCD at Mulago National Referral Hospital, Kampala, Uganda, between November 25, 2014, and July 8, 2015. Severe maternal outcomes (mortality, uterine rupture, hysterectomy, re-laparotomy) and perinatal outcomes (mortality, trauma, low Apgar score, convulsions) were compared between initial delivery mode. Results: Among 13 152 deliveries, 358 women who underwent Vacuum Extraction and 425 women who underwent SSCD were enrolled in the study. No maternal deaths occurred after Vacuum Extraction versus five deaths from complications of SSCD. Vacuum Extraction was associated with less severe maternal outcomes compared with SSCD (3 [0.8%] vs 18 [4.2%]; adjusted odds ratio [aOR] 0.24, 95% confidence interval [CI] 0.07–0.84). Fetal death during the decision-to-delivery interval was also less common in the Vacuum Extraction group (3 [0.9%] vs 18 [4.4%]; aOR 0.24, 95% CI 0.07–0.84); however, the perinatal mortality rate did not differ between the Vacuum Extraction and SSCD groups (29 [8.4%] vs 45 [11.0%], respectively; aOR 0.83, 95% CI 0.49–1.41). One infant in each group exhibited neurodevelopmental anomalies at 6 months. Conclusion: Vacuum Extraction had better maternal outcomes and equivalent perinatal outcomes compared with SSCD. These findings encourage re-introduction of Vacuum Extraction.
Barbara Nolens - One of the best experts on this subject based on the ideXlab platform.
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Health Workers’perspectives on Vacuum Extraction in Mulago Hospital, Uganda
2020Co-Authors: Manuela Capelle, Barbara Nolens, John Lule, Josaphat Byamugisha, Jos Van Roosmalen, Thomas Van Den AkkerAbstract:Abstract Background: The objective of this manuscript is toexplore perceptions of health workersregardingthe use of Vacuum Extraction, two years after the implementation of training programme, in Mulago Hospital, Uganda. Methods: A cross-sectional survey among midwives, residents and consultant obstetricians,was performed. It was composed of questions pertaining to Vacuum Extraction, addressing reasons for low use, recommendations to increase use, preferred mode of birth, views aboutwho is suited to perform the procedure and contraindications.Results: Eighty-threeof 134(61.9%) participants returned the survey. The most frequent reasons for low use of Vacuum Extraction were lack of training (60/83, 72.3%) andequipment (59/83, 71.1%). Skills training and improved supply of equipment were recommended. Most participants (57/83, 68.8%) chose Vacuum Extraction over caesarean section as hypothetical mode of birth forthemselves or a relative. There was a tendency to cite contraindications not identified as such in international guidelines (big baby, caput succedaneum, moulding). Midwives and doctors with appropriate training were generally allconsideredsuited to perform Vacuum Extraction. Conclusion: Health workers generally conveyed a positive attitude towards Vacuum Extraction, despite some perceived barriers, often unsupported by evidence.Organisation of skills training, supply of equipment and focus on knowledge of indications are essential to increase its use.
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Women's recommendations: Vacuum Extraction or caesarean section for prolonged second stage of labour, a prospective cohort study in Uganda.
Tropical medicine & international health : TM & IH, 2019Co-Authors: Barbara Nolens, John Lule, Jos Van Roosmalen, Thomas Van Den Akker, Sulphine Twinomuhangi, Josaphat ByamugishaAbstract:Objectives: To investigate what women who have experienced Vacuum Extraction or second stage caesarean section (CS) would recommend as mode of birth in case of prolonged second stage of labour. Methods: A prospective cohort study was conducted in a tertiary referral hospital in Uganda. Between November 2014 and July 2015, women with a term singleton in vertex presentation who had undergone Vacuum Extraction or second stage CS were included. The first day and 6 months after birth women were asked what they would recommend to a friend: Vacuum Extraction or CS and why. Outcome measures were: proportions of women choosing Vacuum Extraction vs. CS and reasons for choosing this mode of birth. Results: The first day after birth, 293/318 (92.1%) women who had undergone Vacuum Extraction and 176/409 (43.0%) women who had undergone CS recommended Vacuum Extraction. Of women who had given birth by CS in a previous pregnancy and had Vacuum Extraction this time, 31/32 (96.9%) recommended Vacuum Extraction. Six months after birth findings were comparable. Less pain, shorter recovery period, avoiding surgery and the presumed relative safety of Vacuum Extraction to the mother were the main reasons for preferring Vacuum Extraction. Main reasons to opt for CS were having experienced CS without problems, CS presumed as being safer for the neonate, CS being the only option the woman was aware of, as well as the concern that Vacuum Extraction would fail. Conclusions: Most women would recommend Vacuum Extraction over CS in case of prolonged second stage of labour.
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prospective cohort study comparing outcomes between Vacuum Extraction and second stage cesarean delivery at a ugandan tertiary referral hospital
International Journal of Gynecology & Obstetrics, 2018Co-Authors: Barbara Nolens, John Lule, Jos Van Roosmalen, Thomas Van Den Akker, Flavia Namiiro, Josaphat ByamugishaAbstract:Objective: To compare maternal and perinatal outcomes between Vacuum Extraction and second-stage cesarean delivery (SSCD). Methods: The present observational cohort study was conducted among women with term vertex singleton pregnancies who underwent Vacuum Extraction or SSCD at Mulago National Referral Hospital, Kampala, Uganda, between November 25, 2014, and July 8, 2015. Severe maternal outcomes (mortality, uterine rupture, hysterectomy, re-laparotomy) and perinatal outcomes (mortality, trauma, low Apgar score, convulsions) were compared between initial delivery mode. Results: Among 13 152 deliveries, 358 women who underwent Vacuum Extraction and 425 women who underwent SSCD were enrolled in the study. No maternal deaths occurred after Vacuum Extraction versus five deaths from complications of SSCD. Vacuum Extraction was associated with less severe maternal outcomes compared with SSCD (3 [0.8%] vs 18 [4.2%]; adjusted odds ratio [aOR] 0.24, 95% confidence interval [CI] 0.07–0.84). Fetal death during the decision-to-delivery interval was also less common in the Vacuum Extraction group (3 [0.9%] vs 18 [4.4%]; aOR 0.24, 95% CI 0.07–0.84); however, the perinatal mortality rate did not differ between the Vacuum Extraction and SSCD groups (29 [8.4%] vs 45 [11.0%], respectively; aOR 0.83, 95% CI 0.49–1.41). One infant in each group exhibited neurodevelopmental anomalies at 6 months. Conclusion: Vacuum Extraction had better maternal outcomes and equivalent perinatal outcomes compared with SSCD. These findings encourage re-introduction of Vacuum Extraction.
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audit of a program to increase the use of Vacuum Extraction in mulago hospital uganda
BMC Pregnancy and Childbirth, 2016Co-Authors: Barbara Nolens, John Lule, Jos Van Roosmalen, Flavia Namiiro, Josaphat ByamugishaAbstract:Prolonged second stage of labour is a major cause of perinatal and maternal morbidity and mortality in low-income countries. Vacuum Extraction is a proven effective intervention, hardly used in Africa. Many authors and organisations recommend (re)introduction of Vacuum Extraction, but successful implementation has not been reported. In 2012, a program to increase the use of Vacuum Extraction was implemented in Mulago Hospital, Uganda. The program consisted of development of a Vacuum Extraction guideline, supply of equipment and training of staff. The objective of this study was to investigate the impact of the program. Audit of a quality improvement intervention with before and after measurement of outcome parameters. Setting: Mulago Hospital, the national referral hospital for Uganda with approximately 33 000 deliveries per year. It is the university teaching hospital for Makerere University and most of the countries doctors and midwives are trained here. Data was collected from hospital registers and medical files for a period of two years. Main outcome measures were Vacuum Extraction rate, intrapartum stillbirth, neonatal death, uterine rupture, maternal death and decision to delivery interval. Mode of delivery and outcome of 12 143 deliveries before and 34 894 deliveries after implementation of the program were analysed. The Vacuum Extraction rate increased from 0.6 – 2.4 % of deliveries (p < 0.01) and was still rising after 18 months. There was a decline in intrapartum stillbirths from 34 to 26 per 1000 births (-23.6 %, p < 0.01) and women with uterine rupture from 1.1 – 0.8 per 100 births (-25.5 %, p < 0.01). Decision to delivery interval for Vacuum Extraction was four hours shorter than for caesarean section. A program to increase the use of Vacuum Extraction was successful in a high-volume university hospital in sub-Saharan Africa. The use of Vacuum Extraction increased. An association with improved maternal and perinatal outcome is strongly suggested. We recommend broad implementation of Vacuum Extraction, whereby university hospitals like Mulago Hospital can play an important role.To support implementation, we recommend further research into outcome of Vacuum Extraction and into Vacuum Extraction devices for low-income countries. Such studies are now in progress at Mulago Hospital.
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Audit of a program to increase the use of Vacuum Extraction in Mulago Hospital, Uganda
BMC pregnancy and childbirth, 2016Co-Authors: Barbara Nolens, John Lule, Jos Van Roosmalen, Flavia Namiiro, Josaphat ByamugishaAbstract:Prolonged second stage of labour is a major cause of perinatal and maternal morbidity and mortality in low-income countries. Vacuum Extraction is a proven effective intervention, hardly used in Africa. Many authors and organisations recommend (re)introduction of Vacuum Extraction, but successful implementation has not been reported. In 2012, a program to increase the use of Vacuum Extraction was implemented in Mulago Hospital, Uganda. The program consisted of development of a Vacuum Extraction guideline, supply of equipment and training of staff. The objective of this study was to investigate the impact of the program. Audit of a quality improvement intervention with before and after measurement of outcome parameters. Setting: Mulago Hospital, the national referral hospital for Uganda with approximately 33 000 deliveries per year. It is the university teaching hospital for Makerere University and most of the countries doctors and midwives are trained here. Data was collected from hospital registers and medical files for a period of two years. Main outcome measures were Vacuum Extraction rate, intrapartum stillbirth, neonatal death, uterine rupture, maternal death and decision to delivery interval. Mode of delivery and outcome of 12 143 deliveries before and 34 894 deliveries after implementation of the program were analysed. The Vacuum Extraction rate increased from 0.6 – 2.4 % of deliveries (p
