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Operative vaginal deliveries at a district general hospital – an audit
  1. R Latheef1,2,
  2. R Makandar1,
  3. L Roberts1
  1. 1Scunthorpe Genneral Hospital, Scunthorpe, UK
  2. 2Chesterfield Royal Hospital, Chesterfield, UK


Introduction Instrumental deliveries accounts for 10–15% and is associated with increased morbidity to both mother and baby and so there is increased litigation rate.

Aim An Audit was carried out to check the incidence of Instrumental delivery and to assess its safety at Scunthorpe General Hospital. Standards was Royal College of Obstetricians and Gynaecologists Green-top Guideline.

Methods Data were collected retrospectively for 3 months (November–December 2008). 45 notes were available for analysis out of 49 cases.

Results Total number of deliveries in 3 months were 496 out of which 341 (69%) women delivered normally, 49 (10%) had Instrumental deliveries and 106 (21%) had Caesarean sections. Most of the women were nulliparous (39) and full term (41). Indication was abnormal CTG (cardiotocograph) in almost half (21) and Failure to progress in remaining 24 (53%). 4 (9%) women delivered in theatre and three had failed instrumentals which were trials. Documentation about abdominal examination was not mentioned in 28 (62%) cases. Position correctly determined in all but two cases. Kiwi was the favourite instrument and used in more than half of the cases 26 (58%), Forceps was used in 9 (20%), bird ventouse cup in 3 (7%) and >1 instrument used in 7 (15%). 3 women had PPH of >1 L and only half (25) had documentation about examination to identify third/fourth degree tears. Cord blood gases were not carried out in three cases.

Recommendations Recommendations were made to improve documentation, avoid Sequential instruments by proper case selection, proper examination to exclude third/fourth degree tears and to reaudit in 6 months. Proposal for improved standard proforma for documentation was made.

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