Objective To review the choice of instruments for trial of operative vaginal delivery in theatre.
Method Prospective review of trial of instrumental deliveries in a 3 month period. Operators and supervisors career grades were highlighted. The following factors were assessed- Findings on examination, operator's choice of instruments, reasons why instrument were chosen, procedure and delivery outcomes.
Results Of the 34 trial of instrumental deliveries, 4 (11.7%) were done by consultants, 15 (44.1) by Senior registrars and 12 (35.3%) by Junior registrars. 27 (79.4%) chose an instrument because it was most appropriate for the clinical situation, 5 (14.7%) because it was the instrument they were most comfortable with (4 of these operators were junior registrars). 1 (2.94%) was due to consultant advice over the phone and another was unspecified.
Indication for trial was prolonged labour in 27 patients, foetal distress in 12 and maternal exhaustion in 14. The instrument of choice was Neville Barnes forceps in 21 (61.7%), metal cup in 11 (32.3%), silc 1 (2.94%) and kiwi 1 (2.94%).
Vaginal delivery was achieved in 25 (73.5%) and C.S done in 8 (23.5%). 5 of the failed trials were done with ventouse and 3 with forceps.
Conclusion It appears that further guidance and training is required for junior registrars to become skilled in using a varied range of instruments. This will enable them in choosing the instrument most appropriate in clinical circumstances. Our findings corroborate the fact that forceps are more successful in achieving vaginal delivery.
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