Article type
Year
Abstract
Background: Vacuum extraction is a useful procedure for assisted vaginal delivery. Traditionally, it has been recommended that the negative pressure is increased slowly in a stepwise procedure. However, some experts have advocated rapid increases in negative pressure. South East AsiaOptimizing Reproductive and Child Health In Developing Countries (SEA-ORCHID) project aimed to strengthen evidence-based approach to improve health outcome for mothers and babies in developing countries in south East Asia, by interventions designed to strengthen the capacity for research synthesis, evidence-based care and knowledge implementation.
Objectives: To assess the efficacy and safety of rapid versus stepwise negative pressure application for assisted vaginal delivery by vacuum extraction.
Methods: After educator training by SEA ORCHID project, a Cochrane review on technique of negative pressure application was published in 2008. Only one small RCT was included in this review and the evidence was not strong enough to make any recommendation. For more evidence a multicenter RCT was conducted involving six hospitals included general, regional and university hospitals in Thailand, the result was published in the British Journal of Obstetrics and Gynaecology September 2011 and the Cochrane review was updated.
Results: Two trials involving 754 participants were included. One new trial of 660 participants showed the same success rate of vacuum procedure of 98.2%. There was no significant difference in detachment rate, Apgar score below 7 at 1 minute and 5 minutes, other maternal and neonatal morbidities. Whilst there was significant duration reduction in rapid technique.
Conclusions: The rapid negative pressure application reduces duration of the procedure whilst there is no evidence of differences in maternal and neonatal outcomes. Rapid technique of negative application should be recommended for vacuum extraction assisted vaginal delivery. This is an excellent example of routine work to systematic review to multicentre randomized trial and review update.
Objectives: To assess the efficacy and safety of rapid versus stepwise negative pressure application for assisted vaginal delivery by vacuum extraction.
Methods: After educator training by SEA ORCHID project, a Cochrane review on technique of negative pressure application was published in 2008. Only one small RCT was included in this review and the evidence was not strong enough to make any recommendation. For more evidence a multicenter RCT was conducted involving six hospitals included general, regional and university hospitals in Thailand, the result was published in the British Journal of Obstetrics and Gynaecology September 2011 and the Cochrane review was updated.
Results: Two trials involving 754 participants were included. One new trial of 660 participants showed the same success rate of vacuum procedure of 98.2%. There was no significant difference in detachment rate, Apgar score below 7 at 1 minute and 5 minutes, other maternal and neonatal morbidities. Whilst there was significant duration reduction in rapid technique.
Conclusions: The rapid negative pressure application reduces duration of the procedure whilst there is no evidence of differences in maternal and neonatal outcomes. Rapid technique of negative application should be recommended for vacuum extraction assisted vaginal delivery. This is an excellent example of routine work to systematic review to multicentre randomized trial and review update.