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Consultant presence at patients taken to theatre at full dilation: does it improve the outcome in a District General Hospital?
  1. EA Lewis,
  2. K Thomas
  1. Southport and Ormskirk NHS Trust, Southport and Ormskirk, UK

Abstract

Background Caesarean section rates are increasing and locally it was felt that a lot of Caesareans were being done at full dilation which is associated with higher morbidity compared to instrumental deliveries. This study aimed to compare Caesarean sections at full dilatation to successful trials of instrumental deliveries in theatre.

Methods This was a retrospective study at Southport and Ormskirk NHS Trust looking at full dilatation Caesareans and successful trials in theatre between March and September 2009.

Data were collected on a variety of parameters including age, body mass index (BMI), birth weight, grade of doctor, consultant presence, time of delivery and complication rates.

Results There were 31 Caesarean sections at full dilation during the time period (7.2% of all sections). There were 18 successful trials of instrumental deliveries in theatre. There was no difference in parity, age, BMI or birth weight between the two groups.

The presence of a consultant at the time of delivery was associated with a significantly higher chance of having a successful vaginal delivery (p<0.05). Of the Caesarean sections at full dilatation 73% occurred between the hours of 17:00 and 09:00, compared to 61% of successful trials (p>0.05). The rate of postpartum haemorrhage was greater in the Caesarean group (p<0.05) with the average drop in haemoglobin being 2.91 g/dl.

Conclusion Having a Consultant present during the delivery does improve the likelihood of having a successful vaginal delivery when the patient is at full dilatation. Dedicated consultant sessions for 40 h a week and their attendance at trials out of hours will improve outcomes.

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