Trends and operators of instrumental vaginal deliveries in Jos, Nigeria: A 7-year study (1997–2003)

Context: Instrumental vaginal delivery is one of the lifesaving functions of emergency obstetric care to reduce perinatal and maternal morbidity and mortality. Objective: To determine the instrumental vaginal delivery rate, the trends, and the status of their operators in Jos University Teaching Hospital, Nigeria (JUTH) over a 7-year period (1997–2003). Study Design: A 7-year cross-sectional study of obstetric service data from 1st January 1997 to 31st December 2003. Patients and Methods: A register was kept for all cases of instrumental deliveries at JUTH from 1st January 1997 to 31st December 2003. This register with the patient case notes and neonatal ward records was used to conduct this study. Results: During the study period, there were a total of 17,888 deliveries and 349 instrumental vaginal deliveries, giving a rate of 1.95%. Out of these, 238 (68.2%) were vacuum extraction and 111 (31.8%) were forceps delivery. There was a 67% decline in the use of these instruments from 84 (3.18%) in 1997 to 34 (1.05%) in 2003. Majority 313 (90%) of the procedures were performed by residents (Registrars 49%, Senior Registrars 41%). Consultants performed 10%, and all were in the first four years of the study. Forceps delivery rate 0.62% and vacuum delivery rate was 1.33%. There was a strong negative correlation with the performance of IVD in JUTH. At the current trend, no forceps delivery (R = −0.93008) will be performed in JUTH in 2005 while only 4 vacuum deliveries (R = −0.80015) will be conducted in in the same period. Discussion: There is a low instrumental vaginal delivery rate in JUTH with a strong negative correlation in the performance of these procedures. Most procedures are performed by residents, and vacuum is the preferred procedure. Conclusions: Instrumental vaginal delivery in JUTH is a dying art. Training and re-training of resident doctors on this lifesaving function is recommended.