Methods Retrospective, case notes review.

Standards

1. Do antenatal referrals comply with existing pathway?

2. Is there a clear, agreed reason for referral to Urogynaecology?

3. Do all these patients have an agreed plan for delivery?.

StandardsOrigin of standards is from local referral pathway and guideline on management of 3rd and 4th degree tears.

Results 16/22 referrals were appropriate for previous OASIS, faecal urgency or incontinence and urinary incontinence. 6 were inappropriate referrals.

All patients had an agreed delivery plan. Out of the 15 patients who intended to have a vaginal delivery, 11 had a vaginal delivery and 4 had an elective section. Out of 7 patients who were advised to have a Caesarean section- 6 had a Caesarean section and 1 had a vaginal delivery.

Action plan to update the guideline and dissemination of referral criteria to the perineal clinic. Continue good documentation of delivery plan and information to the Obstetric team. To reduce inappropriate referrals to perineal clinic to streamline patient care and reduce waiting list for clinic with referral form. To be audited later in the year for service provision and evaluation. Implications for clinical practice beyond local unit

Agree regional standards for antenatal referral to the perineal clinic.

References

1. Hare A, Olah K. Pregnancy following endometrial ablation: a review article. J Obs Gyn 2005; 25:108–114

2. NICE clinical guideline. Heavy Menstrual Bleeding. 2007

3. Herath R, Singh N, Oligbo N. Antenatal uterine rupture in a pregnancy following microwave endometrial ablation. J Obs Gyn 2010