RESUMO
OBJECTIVES: To investigate what women who have experienced vacuum extraction or second stage caesarean section (CS) would recommend as mode of birth in case of prolonged second stage of labour. METHODS: A prospective cohort study was conducted in a tertiary referral hospital in Uganda. Between November 2014 and July 2015, women with a term singleton in vertex presentation who had undergone vacuum extraction or second stage CS were included. The first day and 6 months after birth women were asked what they would recommend to a friend: vacuum extraction or CS and why. Outcome measures were: proportions of women choosing vacuum extraction vs. CS and reasons for choosing this mode of birth. RESULTS: The first day after birth, 293/318 (92.1%) women who had undergone vacuum extraction and 176/409 (43.0%) women who had undergone CS recommended vacuum extraction. Of women who had given birth by CS in a previous pregnancy and had vacuum extraction this time, 31/32 (96.9%) recommended vacuum extraction. Six months after birth findings were comparable. Less pain, shorter recovery period, avoiding surgery and the presumed relative safety of vacuum extraction to the mother were the main reasons for preferring vacuum extraction. Main reasons to opt for CS were having experienced CS without problems, CS presumed as being safer for the neonate, CS being the only option the woman was aware of, as well as the concern that vacuum extraction would fail. CONCLUSIONS: Most women would recommend vacuum extraction over CS in case of prolonged second stage of labour.
OBJECTIFS: Investiguer ce que les femmes qui ont subi une extraction sous vide ou une césarienne au second stade du travail recommanderaient comme mode d'accouchement en cas de second stade prolongé du travail. MÉTHODES: Une étude de cohorte prospective a été menée dans un hôpital de référence tertiaire en Ouganda. Entre novembre 2014 et juillet 2015, les femmes avec un singleton à terme en présentation de vertex ayant subi une extraction sous vide ou une césarienne de second stade ont été incluses. Le premier jour et six mois après la naissance, on a demandé aux femmes ce qu'elles recommanderaient à une amie: l'extraction sous vide ou la césarienne et pourquoi. Les résultats mesurés étaient: les proportions de femmes choisissant l'extraction sous vide par rapport à la césarienne et les raisons de choisir ce mode d'accouchement. RÉSULTATS: Le premier jour après l'accouchement, 293/318 femmes (92,1%) ayant subi une extraction sous vide et 176/409 (43,0%) femmes ayant subi une césarienne ont recommandé l'extraction sous vide. Parmi les femmes qui avaient accouché par césarienne dans une grossesse précédente et qui avaient eu une extraction sous vide cette fois-ci, 31/32 (96,9%) ont recommandé l'extraction sous vide. Six mois après la naissance, les résultats étaient comparables. Moins de douleur, une période de convalescence plus courte, l'évitement de la chirurgie et la sécurité relative présumée de l'extraction sous vide pour la mère étaient les principales raisons de préférer l'extraction sous vide. Les principales raisons d'opter pour la césarienne étaient l'expérience d'avoir subi une césarienne sans problèmes, la césarienne étant supposée être plus sûre pour le nouveau-né, la césarienne étant la seule option dont la femme était au courant, ainsi que la crainte d'un éventuel échec de l'extraction sous vide. CONCLUSIONS: La plupart des femmes recommanderaient l'extraction sous vide plutôt que la césarienne en cas de second stade prolongé du travail.
Assuntos
Atitude , Cesárea , Segunda Fase do Trabalho de Parto , Complicações do Trabalho de Parto , Preferência do Paciente , Vácuo-Extração , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Apresentação no Trabalho de Parto , Mães , Parto , Gravidez , Estudos Prospectivos , Uganda , Adulto JovemRESUMO
OBJECTIVE: To assess perceptions of women undergoing vacuum extraction or second-stage caesarean section (SSCS) in a tertiary referral hospital in sub-Saharan Africa. METHODS: Prospective cohort study, with six-month follow-up, of women who gave birth to a term singleton in cephalic presentation by vacuum extraction (n = 289) or SSCS (n = 357) between 25 November 2014, to 8 July 2015, in Mulago Hospital, Uganda. Excluded were women who had failed vacuum extraction, severe birth complications and those whose babies had died. Outcome measures were birthing experience satisfaction, physical component summary (PCS) and mental component summary (MCS) of the SF-12 quality-of-life questionnaire, pain scores and dyspareunia. RESULTS: One day after vacuum extraction, 63.7% (181/284) of women were feeling well vs. 48.1% (167/347) after SSCS (OR 1.89; 95%CI 1.37-2.61) and mean pain sores were 2.70 vs. 3.87 (P < 0.001). In both groups, >90% of women were satisfied with their birthing experience. At six weeks, in vacuum extraction vs. SSCS, mean pain sores were 0.40 vs. 0.89 (P < 0.001); mean PCS was 48.67 vs. 44.03 (P < 0.001); mean MCS was 52.80 vs. 51.23 (P = 0.203); 40% (70/175) vs. 28.3% (70/247) of women had resumed sexual intercourse (OR 1.69; 95%CI 1.12-2.54) and 21.4% (15/70) vs. 28.6% (20/70) had dyspareunia (OR 0.68; 95%CI 0.32-1.47). No differences were found at six months after birth. CONCLUSION: One day and six weeks after birth, outcomes were better in women who had vacuum extraction. At six months, outcomes were similar. To promote quick recovery, vacuum extraction should be the first intervention considered in the second stage of labour.