摘要
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Not in the departmental protocol (26.2%), Not evidence based (34.6%), Patient preferred Caesarean section (5.6%), Outdated (32.6%), fear of litigation (32.7%).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.
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.
