Operative vaginal delivery at Port Moresby General Hospital from 1977 to 2010

This paper presents 35 years of history of operative vaginal delivery at the Port Moresby General Hospital (PMGH). From the early 1970s when Dr. G.C. Bird was appointed as Head of Obstetrics at PMGH, vacuum extraction has been the preferred method of assisted vaginal delivery. In the early 1970s, Dr Bird began to experiment with more effective configurations of the then standard metal Malmstrom vacuum extraction cup: the Bird anterior cup was introduced in 1973 and the posterior cup in 1974. These modifications to the vacuum extractor cup allowed for more effective placement of the cup on the flexion point on the fetal head thereby facilitating more successful vacuum-assisted delivery. Between 1977 and 2010 there were a total of 11,458 vacuum extractions (average rate 3.9%) performed, with an average failure rate of 2.5%. During the same period there were 565 vaginal forceps deliveries (rate 0.2%), 11,550 caesarean sections (rate 3.9%) and 182 symphysiotomies (all for failed vacuum extraction procedures) performed. Over the period trends that are noted include a slowly rising caesarean section rate from 2% in the 1970s to nearly 5% in the current decade. Over the same period the assisted vaginal delivery rate has dropped from 10-15% in the 1970s to 3-4% since 2000. The combined fresh stillbirth and early neonatal mortality rate for infants > or = 1.5 kg and > or = 2.5 kg for the period was 11.3/1000 and 9.5/1000 respectively, and compares to a combined fresh stillbirth and early neonatal mortality rate of 8.7/1000 for assisted vaginal delivery.