Rate and Neonatal Outcomes Among Instrument Assisted Vaginal Birth in 12 Public Hospitals in Nepal

Abstract Background Instrument assisted vaginal birth (IVB) is an effective intervention for deliveries complicated by prolonged labour or fetal distress, but its use is declining in many low-resource settings. In this paper, we examined intra-hospital rates of IVB, factors associated, and neonatal outcomes after IVB in Nepal. Methods This is a prospective cohort study of all deliveries conducted in 12 public hospitals (4 high volume, 4 medium volume and 4 low volume) across Nepal for 18 months . We calculated the rate of IVB and used logistic regression to assess the association between IVB and neonatal morbidity (Apgar score < 7 at 5 minutes, shoulder dystocia) and mortality.Results A total of 81,581 deliveries were included in the study, of which 3001 (3.4%) were IVBs., while rates in high volume, medium volume, and small volume hospitals were 3.6%, 3.7% and 1.2% respectively. The odds of Apgar score < 7 at 5 minutes was almost three-fold (aOR 2.92, 95% CI, 2.49-3.42) with IVB compared to spontaneous vaginal birth (SVB). The odds of shoulder dystocia was three-fold (aOR 3.04, 95% CI, 2.19-4.22) with IVB compared to SVB. The odds of first day mortality was lower in medium volume (aOR-0.57, 95% CI, 0.42-0.78) hospitals compared to high volume hospitals. Conclusions The rate of IVB varied by volume of hospital. The neonatal outcome were poor among the babies born to IVB, and neonatal outcomes were worse after IVB at high-volume hospitals. Further studies to explore factors determining the rate of IVB and better neonatal outcomes.