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Does the presence of a consultant on the delivery suite reduce the emergency caesarean section rate?
  1. A Khalil,
  2. N Suff,
  3. M Blott,
  4. P O'Brien
  1. Department of Obstetrics, Institute for Women's Health, University College London Hospitals NHS Foundation Trust, London, UK

Abstract

Background There is a widespread assumption, but limited evidence, that consultant presence on the delivery suite improves obstetric outcomes.

Objectives The main objective was to evaluate whether consultant presence on the delivery suite is associated with a lower emergency caesarean section (CS) rate. The secondary aim was to assess the effect of type of subspecialty training on the rate of emergency CS.

Methods A retrospective review of all emergency CS at a tertiary referral obstetric unit between July 2009 and December 2010. Elective CS deliveries were excluded. The emergency CS rate was compared between periods with and without consultant presence. Delivery Suite is covered by a senior registrar (usually a subspecialty trainee) when a consultant is not present. We also compared the emergency CS rate between sessions covered by obstetrics and gynaecology subspecialty senior registrars.

Results During this 18-month period, there were 8051 deliveries (1502 emergency CS). The emergency CS rate during consultant time was 17.9%, compared with 21.5% in senior registrar time (p<0.0001). This trend held true for each indication for emergency CS: failure to progress, presumed fetal distress and others (p<0.05). The emergency CS rate was significantly higher in the periods covered by gynaecology compared with obstetric subspecialty senior registrars (p<0.05).

Conclusions Our study supports the belief that Consultant presence on the Delivery Suite reduces intervention, specifically the emergency CS rate. It reinforces the recommendation that consultant presence should be increased, particularly in higher risk units.

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