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When to do trial of operative vaginal delivery in theatre and how to improve success rate?
  1. J Raut,
  2. D Kapoor,
  3. S Amirchetty
  1. Nottingham University NHS Trust, City Campus, Nottingham, UK


Women who labour, are aiming for vaginal delivery and therefore efforts should be focused on helping them to achieve this. Operative vaginal delivery (OVD) remains integral part of the obstetricians' duties. We, in a University Hospital, have extensive local protocol to follow in the situation like it should be confirmed by SR/Consultant before transfer; record of abdominal and VE findings; SR/Consultant should be present in theatre. It was a prospective audit involving all 43 cases. In 84% of cases primary indication were malpositions. 60% of cases, positions had been confirmed by senior registrar/consultant and in 11 cases findings had been changed. In 90% cases abdominal examination were undertaken however fetal size estimated only in handful of cases. Though position and stations were widely documented, caput and moulding were not that well documented. Senior experience were available in theatre in most cases. Manual rotation were most popular (60%) and keilland's forceps were done in 30% cases. Neville-Barnes forceps had been used most cases. 10% cases were tried with double instrumentation. 88% cases vaginal delivery were achieved. Time from decision to arrival in theatre were 4–37 min, mean 19.2 and from arrival in theatre to delivery 16–53 min, mean 27.3. Cord gas showed pH <7.25 in seven cases. Apgar's were <7 in 5 min in one baby and was admitted to NNU. 9% had PPH. It was concluded that right people were present in theatre, most (88%) delivery has been achieved vaginally, most babies were born in good condition.

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