Audit on trial of instrumental deliveries. (7th June 2011) - Lawson, B
Abstract : Background: It is estimated that instrumental vaginal deliveries account for 10–15% of births in the UK. To improve the safety of these deliveries, the RCOG has issued guidelines, which include recommendations for patients who should be managed as a trial in theatre, with immediate recourse to caesarean section when necessary. Objectives: To compare current practice with RCOG Guideline No.26 on Operative Vaginal Delivery, to determine the incidence of operative vaginal deliveries in our unit and to compare the outcome of deliveries carried out in the delivery room as compared to theatre. Methodology: A prospective clinical audit was carried out between 15 March 2010 and 15 April 2010. A total of 61 charts were analysed. Results: The incidence of operative vaginal deliveries was 14.8% of all deliveries. Strict adherence to RCOG guidelines indicates that 11 cases should have been managed as a trial in theatre (2 with BMI >30; 9 with mid-cavity fetal station). Seven cases required caesarean section, all with fetal malposition. Two babies were admitted to NNU, one because of known duodenal atresia and one with breathing difficulties. Conclusions: The high rate (100%) in achieving a vaginal delivery in cases selected for instrumental assistance in delivery room indicates good clinical judgement among medical staff. Figure 1 demonstrates delivery outcome according to method of first choice.