9 other significant complications were recorded in the register as having occurred in successful vacuum deliveries: 5 PPH, 3 shoulder dystocia and 1 cephalohaematoma. All had apparently good outcomes. Discussion Although vacuums are by definition high risk deliveries, the overall outcomes of this cohort of patients, delivered by mostly junior generalists in a deeply rural district hospital, are reasonably good and within the range of outcomes reported from elsewhere, including developed countries. The rate of vacuum assisted deliveries is within ranges reported from elsewhere, but is one of the highest rates in South Africa. Comparison with the 2012/2013 Saving Babies report suggests that 7.7% of all vacuums performed at district hospital in South Africa are done at Zithulele, but only 0.6% of the deliveries. With respect to neonatal outcomes, there were no stillbirths. The neonatal mortality rate, NMR, (including failed vacuums but excluding known IUDs) was 11.9 per 1000. As expected this is a bit higher than the overall NMR of 9.3 per 1000 for all babies >1000g in our unit, but significantly more than the 4.3 per 1000 for babies over 2500g in the same period. The NMR is higher than we’d like, but in our setting where relatively junior staff manage challenging labours, we propose that our vacuum rate is a good thing as it saves caesarean sections and their concomitant risks, while maximising fetal outcomes. The large number of practitioners involved – most of whom had performed few or no vacuum deliveries prior to working at Zithulele – shows that skills can be passed on between generalist doctors even in a rural environment. Because this was a register review it is possible that other neonatal complications, such as conjunctival haemorrhage were under diagnosed and or under reported. Maternal outcomes were good, with generally few recorded complications. There is a possibility that this may partly be due to recording omissions. The main complication was maternal perineal injury. There was a relatively high rate of third degree tears
9 other significant complications were recorded in the register as having occurred in successful vacuum deliveries: 5 PPH, 3 shoulder dystocia and 1 cephalohaematoma. All had apparently good outcomes. Discussion Although vacuums are by definition high risk deliveries, the overall outcomes of this cohort of patients, delivered by mostly junior generalists in a deeply rural district hospital, are reasonably good and within the range of outcomes reported from elsewhere, including developed countries. The rate of vacuum assisted deliveries is within ranges reported from elsewhere, but is one of the highest rates in South Africa. Comparison with the 2012/2013 Saving Babies report suggests that 7.7% of all vacuums performed at district hospital in South Africa are done at Zithulele, but only 0.6% of the deliveries. With respect to neonatal outcomes, there were no stillbirths. The neonatal mortality rate, NMR, (including failed vacuums but excluding known IUDs) was 11.9 per 1000. As expected this is a bit higher than the overall NMR of 9.3 per 1000 for all babies >1000g in our unit, but significantly more than the 4.3 per 1000 for babies over 2500g in the same period. The NMR is higher than we’d like, but in our setting where relatively junior staff manage challenging labours, we propose that our vacuum rate is a good thing as it saves caesarean sections and their concomitant risks, while maximising fetal outcomes. The large number of practitioners involved – most of whom had performed few or no vacuum deliveries prior to working at Zithulele – shows that skills can be passed on between generalist doctors even in a rural environment. Because this was a register review it is possible that other neonatal complications, such as conjunctival haemorrhage were under diagnosed and or under reported. Maternal outcomes were good, with generally few recorded complications. There is a possibility that this may partly be due to recording omissions. The main complication was maternal perineal injury. There was a relatively high rate of third degree tears
Proceedings-2015.docx