Vacuum assisted delivery in Ecuador for prolonged second stage of labor: Maternal-neonatal outcome

Background. In South America, and particularly Ecuador, cesarean section rates have risen markedly over the past five years. The associated increases in maternal morbidity and healthcare costs indicate the need for alternative strategies. Operative vaginal delivery is minimally utilized in Ecuador, as neither vacuum nor forceps have been available. Objective. As vacuum delivery was recently introduced to our clinical service, we sought to examine our initial experiences (i.e., maternal and neonatal outcome) with operative vaginal delivery for prolonged second stage of labor. Methods. Following an initial educational program at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil, Ecuador, vacuum extraction cups (Mityvac®, Cooper Surgical) were offered to laboring women with term singleton gestations and cephalic presentations no higher than +3 station. Maternal and neonatal data were analyzed. Results. During the study period, 100 vacuum applications were performed on laboring women complicated with prolonged second stage of labor. Mean maternal age was 23.8 ± 6.4 years (range14-41 years) with 57% of patients nulliparous. Left anterior and right posterior fetal positions were the most frequent (85% and 11%, respectively). Maternal complications included need for blood transfusion (1%), shoulder dystocia (1%) and perineal tears (first degree 6%, second degree 5%). Vaginal delivery was successful in 97% of cases. Among neonates, the average weight was 3149 ± 410 g, with 10% neonates small for gestational age and 5% large for gestational age. Only 1% of infants presented an Apgar score <7 at 5 min. There were no scalp lacerations, cephalohematomas, or subgaleal bleeds. Conclusions. In this initial observational study, vacuum extraction for prolonged second stage was safe and effective. We propose that the introduction of operative vaginal delivery to developing countries will mitigate rising cesarean section rates.