Detailed statistics on individual acchouchers have been kept from 2009 at JCUH. This paper is based on that data. It considers the influence of individual acchouchers on the success rate of second stage delivery in theatre.
Consultant attendance is currently 92%. Before the introduction of 98 hour cover attendance was 74%.
There was considerable variation in the success rates of individual achouchers from 20–78%. If instrumentation was attempted then rates varied from 40–87%.
Complication rates of the successful trials were compared. The consultants were split into three groups:
Success rate of ≤ 40%
Success rate of 41–70%
Success rate of > 70%
The least maternal complications (third/fourth degree tear and PPH > 1.5 l) occurred in the group with the highest success rate.
The number of neonatal complications (NNU admission of a baby > 37 weeks, apgar < 7 at 5 mins, cord ph < 7.1 and shoulder dystocia) were very small but they did not increase in the group with the higher delivery rate.
Conclusions there is considerable variation in success rates in women taken to theatre in the second stage dependant on the acchoucher. If we are to lower the caesarean section rate we need to look at the skills of individuals. A higher success rate does not appear to be associated with a higher complication rate. Further assessment is required looking at the complications of caesareans in the second stage. Data collection has commenced in 2012 to try and look at this further.
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