Trends and Determinants of Operative Vaginal Delivery at Two Academic Hospitals in Johannesburg, South Africa 2005–2019

Abstract

Operative Vaginal delivery (OVD) can reduce perinatal and maternal morbidity and mortality especially in low resource setting such as South Africa. We evaluated the trends and determinants of OVD rates using join point regression at Charlotte Maxeke Johannesburg (CMJAH) and Chris Hani Baragwaneth (CHBAH) Academic Hospitals from 1 January 2005–31 December 2019 and conducted a comparative study of OVD (n = 179) and normal delivery (n = 179). Over the 15-year study period (2005–2019), 323,617 deliveries and 4391 OVDs were conducted at CHBAH giving an OVD rate of 1.36 per 100 births. In CMJAH, 74,485 deliveries and 1191 OVDs were conducted over an eleven-year period (2009–2019) with OVD rate of 1.60 per 100 births. OVD rate at CHBAH increased from 2005–2014 at 9.1% per annum and declined by 13.6% from 2014–2019, while OVD rates fluctuates at CMJAH. Of the 179 patients who had OVD, majority (n = 166,92.74%) had vacuum. Women who had OVDs were younger than those who vaginal delivery (p-value < 0.001). The prevalence of OVDs was higher among nulliparous women (p-value < 0.001), HIV negative women (p-value = 0.021), underweight (p-value < 0.001) as compared to normal delivery. The OVD rates has dramatically reduced over the study period This study heightens the need to further evaluate barriers to OVD use in our environment