A comparative study of neonatal and maternal outcome between forceps delivery and vacuum extraction

Background: Aims and objectives of the study were to compare maternal and neonatal outcomes of forceps versus vacuum application in assisted vaginal delivery. Methods: This prospective study was conducted in a tertiary care hospital of West Bengal over one year. Women in labor with vertex presentation were delivered by vacuum and forceps. A total of 100 cases were included of which 50 patients selected for forceps delivery and 50 patients for vacuum extraction. The instruments were either silastic cup vacuum extractor or Wrigley`s outlet forceps. Maternal morbidity was studied in terms of cervical tears, vaginal lacerations, episiotomy extension, perineal tears, PPH, and retention of urine. Neonatal morbidity was studied in terms of Apgar score, instrumental injuries, cephalhematoma, NICU admission and the outcome was compared. Chi square test was used to analyze the data. Results: Observations maternal morbidity viz. episiotomy extension, traumatic PPH were significant in the forceps group (p=0.01). With regards to neonatal morbidity, SNCU admission were significantly higher in forceps delivery (p=0.02) and incidence of cephalohematomas were more in ventouse delivery (p=0.02). Conclusions: Vacuum and forceps should remain appropriate tools in the armamentarium of the modern obstetrician. However, ventouse may be chosen first (if there is no fetal distress) as it is significantly less likely to injure the mother.

Forests of learning : experiences from research on an adaptive collaborative approach to community forestry in Nepal; a synthesis of lessons from the Adaptive Collaborative Management Research Project in Nepal, 1999–2002 and 2004–2007

In recent years, awareness has grown in Nepal and globally regarding two of community forestry’s most critical challenges: equity and livelihoods. Yet even as understanding of these challenges has improved, actors from the local to the national levels in Nepal continue to be confronted with the dilemma of how to address these challenges in such a diverse, complex and dynamic context. This synthesis explores an adaptive collaborative approach to governance and management as one avenue to meet these challenges. This approach integrates inclusive decision making, networking, social learning, and pro active adjustments of practice and policies based on learning. The synthesis’ lessons are drawn from a six-year partnership-based research initiative in Nepal—spearheaded by the Center for International Forestry Research—which spanned the local, district and national levels. Key points of learning discussed in this book include factors, processes and arrangements that support—or limit—adaptive and collaborative capacities, such as active facilitation, ‘nested’ decision making, and learning-based monitoring. The book also explores both the conceptual underpinnings of the approach as well as its effects in research sites, including in terms of benefits for the poor, women and other traditionally marginalised people. This book is intended as a resource for policy makers and civil society practitioners alike, as well as researchers and others interested in pro-equity and livelihood innovations in community forestry. Through its clear conceptual and research lesson focus, this synthesis complements and is a sister publication to the hands-on guidebook entitled Facilitating Forests of Learning