Study design and setting
Facility based retrospective cross-sectional study was conducted at maternity ward of felege Hiwot Comprehensive Specialized Hospital. This hospital is located in bahir dar city which found approximately 565 km North West of Addis Ababa.
The hospital has obstetrics, gynecology, paediatrics, internal medicine, ophthalmology & orthopaedic surgery services. The labor ward gives services to around 612 deliveries per month. The Department of Obstetrics and Gynaecology has a labor ward with seven beds in first stage room, two delivery couches in the second stage room, four beds in the recovery unit and sixty-nine beds in the maternity ward, along with two operating rooms.
SOURCE POPULATION: mothers who had instrumental vaginal delivery in Felege Hiwot comprehensive specialized hospital from December 1, 2015 to November 30, 2017.
STUDY POPULATIONS: mothers who had instrumental vaginal delivery in Felege Hiwot comprehensive specialized hospital from December 1, 2015 to November 30, 2017.
SAMPLE SIZE DETERMINATION:
The sample size was determined by using a single population proportion formula after considering the following assumptions:
Proportion of maternal complication related to instrumental vaginal delivery account for 59.8% from previous studies . By taking 5% Marginal error and 95% Confidence interval, the required sample size was 369. After adding 10% for incomplete secondary data, the final sample size was 406.
Mothers who gave birth through instrumental vaginal delivery from Dec1, 2015 to Nov 30, 2017 were 820. Systematic random sampling technique was applied to select the study participant's from records. So to find the sampling fraction; the total number of women who gave birth through instrumental vaginal delivery from Dec1, 2015 to Nov 30, 2017 which was 820 divided by a total number of sample size (406) and it was approximately 2. First, the second woman's chart (record) was selected by lottery method then every other woman's chart was recruited for the study (Fig S1).
INCLUSION AND EXCLUSION CRITERIA
INCLUSION CRITERIA: Medical records of all instrumental deliveries in the hospital from December 1, 2015 to November 30, 2017 were included in the study.
EXCLUSION CRITERIA: incompletely documented chart (chart which does not include all variable) and C/S delivery after failed instrument are excluded.
Socio-demographic, obstetric, enabling and Instrumental delivery related variables
Socio-demographic, obstetric, medical and other factors were examined as a potential predictor in this analysis. Socio-demographic factors include age and place of residence. Obstetric related factors include parity, number of pregnancy, gestational age, BW(birth weight), Fetal presentation/position, station, current pregnancy type, frequency of ANC visit, duration of labour and Obstetric indications for IVD( prolonged second stage, non-reassuring Fetal heart rate pattern, poor maternal effort, APH/abruption, after coming head of breech presentation, MSAF). Enabling factors include the type of hospital visit, instrument available and availability of electronic Fetal monitoring (CTG used). Instrumental delivery related variables include types of instrument, the presence of episiotomy and type of episiotomy.
Maternal complication: maternal complication related to instrumental delivery are the presence of at least one of the following (perineal tear, cervical laceration, vaginal laceration, episiotomy extension, traumatic haemorrhage (primary PPH), urinary retention, uterine rupture) .
DATA COLLECTION INSTRUMENTS
Data collection checklist was adapted and modified from different studies[8-10].
DATA PROCESSING AND ANALYSIS
Collected data were entered into EPI Info version 7 then exported to SPSS version 23 for analysis. Descriptive statistics used to describe the main features of the data. Bivariate analysis was done to identify candidate variable using p≤ 0.2. Multivariate logistic regression was used to control effect of confounder and variable with p≤0.2 was included in multivariable logistic regression analysis. Finally statistical significance declared at p-value<0.05.