TITLE:
Declining Rate of Operative Vaginal Deliveries in Nigeria
AUTHORS:
Okechukwu Bonaventure Anozie, Lawani Lucky Osaheni, Fidelis A. Onu, Robinson Chukwudi Onoh, Emeka Onwe Ogah, Justus N. Eze, Johnbosco E. Mamah, Obiora G. Asiegbu, Rita O. Anozie
KEYWORDS:
Invasive Obstetric Procedures, Decline, Nigeria
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.8 No.3,
March
13,
2018
ABSTRACT: Background: The application of invasive obstetric procedures has an end point of
reducing the Caesarean section rate. The declining rate of use of these
procedures is one of the reasons for increasing Caesarean section rates in our
environment. Objective: The aim of the study was to determine the
practice of operative vaginal deliveries among obstetricians practicing in
Nigeria and to evaluate the reasons for non-use of these procedures. Methodology: It was a questionnaire based study. The questionnaires were administered
to practitioners of Obstetrics in the various centres in Nigeria. Data was
collated and analyzed with Epi-Info statistical software version 7.0 (Center
for Disease Control and Prevention, USA), and conclusions were drawn by means
of descriptive statistics. Results: A total of 1200 questionnaire were distributed but 1104 were returned
and used for analysis. This gave a response rate of 92%. The age distribution
of the respondents showed that the 20 - 30 year
age group had the least number of respondents 22 (2%) while 41 - 50 age
group had the highest number of respondents 486 (4%). The majority of the respondents
were males 839 (76%). In terms of duration of practice, 449 (40.7%) of the
respondents had more than 6 years duration of practice while 256 (23.2) had
practiced for less than 3 years. Tertiary centres had highest number of
respondents 71.8%. The distribution of the respondents according to the geopolitical zones
in Nigeria are; South-East (57.6%), South-South (19.6%), South West (11.4%),
North-West (4.9%), North-East (3.8%), North-Central (2.7%). The
practice of these procedures among respondents were: External cephalic version
(68.0%), Symphysiotomy (41.7), Forceps delivery (68.8%), Destructive delivery
(60.1%), Vaginal breech delivery (85.5%), Vacuum extraction (84.8%). Reasons
for the non-use included: Risk of perinatal/maternal morbidity and mortality
greater than benefit (25.7%), Lack of equipment (22.4%), Lack of skills (16.6%),
Decline by patients (6.5%), Not in the departmental protocol (26.2%), Not
evidence based (34.6%), Patient preferred Caesarean section (5.6%), Outdated
(32.6%), fear of litigation (32.7%). The mean rate of caesarean section
according to rates reported from different centres was 25.2% while the
individual centre rates ranged from 2% to as high as 51%. Conclusion: There is a decline in the practice of operative obstetric procedures
among obstetricians practicing in Nigeria. There is an urgent need to reverse
this trend by increased training and re-training of manpower, provision of
necessary equipment, more research to provide supportive evidence of need and inclusion in protocols.