Predictors of adverse perinatal and maternal outcomes of instrumental vaginal delivery at a tertiary setting in Ethiopia: A cross-sectional study

Abstract

Objective: To determine the rate of instrumental vaginal delivery (IVD) and the predictors of adverse maternal and fetal outcomes associated with it in an Ethiopian setting. Methods: A cross-sectional study was conducted from October 1, 2018, to January 31, 2019, at St. Paul's Hospital Millennium Medical College (SPHMMC) (Addis Ababa, Ethiopia). Data on obstetric characteristics, perinatal and maternal outcomes of women who delivered through IVD were collected prospectively, using a structured questionnaire. Data were analyzed using SPSS version 22 and descriptive analysis was applied to analyze baseline characteristics. Multivariable logistic regression model was fitted to predict the association between short-term complications of IVD and their determinants. Odds ratio, 95% CI, and p-value < 0.05 were used to present significance of study findings. Results: There were 3165 deliveries during the study period, out of which 241 (7.6%) were instrumental vaginal deliveries. Sequential use of instrumental delivery (AOR = 4.82 [95% CI = 2.10–27.29] and AOR = 6.43 [95% CI = 1.19–34.73], for maternal and fetal complications, respectively) was associated with increased both maternal and fetal complications. Three number of pulls during the extraction was associated with increased fetal complications (AOR = 1.19 [95% CI = 1.05–1.67]). Conclusion: The rate of instrumental delivery rate in our setting is high with sequential use of instrumental delivery found to be associated with increased adverse maternal and fetal outcomes while three number of pulls were associated with increased fetal adverse outcomes.