Background: The application of invasive obstetric procedures has an end\npoint of reducing the Caesarean section rate. The declining rate of use of these\nprocedures is one of the reasons for increasing Caesarean section rates in our\nenvironment. Objective: The aim of the study was to determine the practice\nof operative vaginal deliveries among obstetricians practicing in Nigeria and\nto evaluate the reasons for non-use of these procedures. Methodology: It was\na questionnaire based study. The questionnaires were administered to practitioners\nof Obstetrics in the various centres in Nigeria. Data was collated and\nanalyzed with Epi-Info statistical software version 7.0 (Center for Disease\nControl and Prevention, USA), and conclusions were drawn by means of descriptive\nstatistics. Results: A total of 1200 questionnaire were distributed but\n1104 were returned and used for analysis. This gave a response rate of 92%.\nThe age distribution of the respondents showed that the 20 - 30 year age\ngroup had the least number of respondents 22 (2%) while 41 - 50 age group\nhad the highest number of respondents 486 (4%). The majority of the respondents\nwere males 839 (76%). In terms of duration of practice, 449 (40.7%)\nof the respondents had more than 6 years duration of practice while 256 (23.2)\nhad practiced for less than 3 years. Tertiary centres had highest number of\nrespondents 71.8%. The distribution of the respondents according to the geopolitical\nzones in Nigeria are; South-East (57.6%), South-South (19.6%), South\nWest (11.4%), North-West (4.9%), North-East (3.8%), North-Central (2.7%).\nThe practice of these procedures among respondents were: External cephalic\nversion (68.0%), Symphysiotomy (41.7), Forceps delivery (68.8%), Destructive\ndelivery (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%),\nLack of skills (16.6%), Decline by patients (6.5%), Not in the departmental\nprotocol (26.2%), Not evidence based (34.6%), Patient preferred Caesarean\nsection (5.6%), Outdated (32.6%), fear of litigation (32.7%). The mean rate of\ncaesarean section according to rates reported from different centres was 25.2%\nwhile the individual centre rates ranged from 2% to as high as 51%. Conclusion:\nThere is a decline in the practice of operative obstetric procedures\namong obstetricians practicing in Nigeria. There is an urgent need to reverse\nthis trend by increased training and re-training of manpower, provision of\nnecessary equipment, more research to provide supportive evidence of need\nand inclusion in protocols.
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