Abstract

The majority of instrumental deliveries are conducted in the delivery suite. However, in a small proportion (2–5%) where delivery is anticipated to be difficult, a trial of instrumental delivery in theatre is done with preparations for Caesarean section (CS). The authors aimed to compare current practice in our hospital to established guidelines, and to compare maternal and neonatal outcomes to published literature.

Data were collected from the Obstetric Theatre register, supplemented by chart review of patients who had a trial of instrumental delivery in theatre from 1 July 2009 to 31 December 2009. Auditable standards included decision-to-delivery-interval (DDI), consultant presence, and record of cord pH. Outcomes measured included mode of delivery, postpartum haemorrhage and neonatal unit admission.

797 instrumental deliveries occurred during this period. 65 women (65/797; 8%) had a trial in theatre; 52 (80%) were successful and 13 (20%) had emergency CS. 31 were attended by a consultant (31/65; 48%). The median DDI was 34 min (range 3–90). 32 deliveries (32/65; 49%) occurred between 20:00 to 8:00; 11 (11/32; 34%) of these were attended by consultants. Nulliparaous women were more likely to have an emergency CS (p value 0.01). There were no significant difference in maternal or neonatal outcome.

The number of trials in our unit was higher than published data, with comparable failure rates. 49% occurred after hours, where consultant presence could reduce the need for a trial. DDI is in-keeping with established recommendations, however, documentation of cord pHs needs improvement. Maternal and neonatal outcome was comparable to published literature.