The PCT required an audit to be completed across the University Hospitals Leicester Trust in the light of new NICE guidance on Caesarean section for maternal request. This was combined with an audit of infection control and thromboprophylaxis measures for CQUIN targets. An audit of Vaginal Birth After Caesarean as compared with projected outcome of VBACs published by the RCOG was opportunistically carried out at the same time.
Data were prospectively collected on patients undergoing CS in January 2012 by the theatre team in 171/191 (89%) of all patients undergoing caesarean section and VBAC data were collected from the patients’ computerised and paper notes.
Targets were met for Antibiotic prophylaxis and use of clippers, VTE prophylaxis, Diabetic control and counselling against CS for maternal request.
Targets were not met for written and verbal debriefing post CS, nor prescribing of Stellisept.
Diabetes rate 6% across UHL
Hypertension rate 16% across UHL
100% UHL patients had an AN discussion about mode of delivery
CS Rate 21% across UHL
Only 24% those that could have attempted VBAC chose ERCS (LRI)
VBAC success rate 64.3% in those who attempted it (LRI)
CS Maternal request - 4 cases/171 2.3%
NICE CG 132 220.127.116.11
Documented adequate counselling 100%
Explored reasons for request 100%
Conclusion The audit was reassuring in not only its prophylactic measures but also that very reasonable successful VBAC rates and CS rates are achievable in even a tertiary unit.
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