TEMPLATE DESIGN © 2008 Outcome of trial of instrumental delivery in theatre Dr Uma Mahesha Arava,...
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TEMPLATE DESIGN © 2008 www.PosterPresentations.com Outcome of trial of instrumental delivery in theatre Dr Uma Mahesha Arava, Dr Toli S Onon University Hospital of South Manchester, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT, England. Introduction 1 Instrumental deliveries account for an estimated 10-15 % of births in the UK 2 . The choice of instrument and the experience of the accoucheur have been identified as risk factors for both fetal and maternal morbidity, 3,4 and to further improve the safety of instrumental vaginal delivery, the Royal College of Obstetricians and Gynaecologists(RCOG) have issued guidelines which include recommendations for patients who should be managed as a trial of instrumental delivery in theatre, with immediate recourse to Caesarean section when necessary. 5 We undertook a retrospective study to look at specific fetal and maternal outcomes associated with instrumental delivery in theatre and also assess factors related to success or failure of instrumental delivery. Methodology Data was collected retrospectively utilising theatre records, from all trials of instrumental deliveries in theatre over a 12 month period. 80 women underwent a trial of instrumental delivery and information recorded included parity, gestation, onset of labour, fetal blood sampling, fetal position, presence of caput and moulding, indication for trial, instrument used, use of sequential instruments, reason for failure of instrumental delivery, grade of operator, eventual mode of delivery, perineal tears, cord ph and Apgar scores. Results • Of the 56 successful trials, 8 women had 3 rd degree perineal tears with a rate of 14%. • 86% of women who went to theatre for a trial were primiparous. • Occipito posterior and occipito transverse position were associated with 65% of failed instrumental deliveries. • There were 7 (9%) cases of Cord arterial ph < 7.1 with 4 and 3 cases when the trial was successful and failed respectively. • There was 1 instance when the Apgar score was < 7 at 5 minutes (successful trial). Conclusions References In our cohort, the success rate of trial of instrumental delivery in theatre was 70% with a 14% incidence of third degree perineal tears when the trial was successful. Trial of instrumental delivery was more common in primiparous women than multiparous women. Failure was more likely with fetal malposition and failure of descent with traction. Operative vaginal delivery should be abandoned when there is no evidence of descent with moderate traction during each contraction or when delivery is not imminent following three contractions of a correctly applied instrument by an experienced operator. OPTIONAL LOGO HERE OPTIONAL LOGO HERE 1. Olagundoye V, MacKenzie I. The impact of a trial of instrumental delivery in theatre on neonatal outcome. BJOG 2007;114:603–608. 2. Thomas J, Paranjothy S. The National Sentinel Caesarean Section Audit Report. London: RCOG Press, 2001. 3. Johanson R,Menon BKV. Vacuum extraction vs forceps delivery (Cochrane review). In: The Cochrane Library. Oxford, UK: Update software; 1999. 4. RCOG. Operative Vaginal Delivery. Guideline 26, 1–6. London: Royal College of Obstetricians and Gynaecologists, 2000. 5. RCOG. Operative Vaginal Delivery. Guideline 26, 1–13. London: Royal College of Obstetricians and Objectives To study the rate of success of instrumental delivery in theatre, rate of sequential instrumental use, rate of third degree perineal tears, cord ph <7.1 and Apgars <7 at 5 minutes. Results Success S uccess 70% Failure 30% S uccess Failure 56 patients underwent successful trial of instrumental delivery with a success rate of 70% and failure rate of 30%. 51 13 8 3 1 1 3 0 10 20 30 40 50 60 1 P rolonged 2nd stage PathologicalCTG SuboptimalCTG Suspected fetal distress Abruption Breech Not.doc. The most common indication for a trial was failure to progress in the second stage of labour. • Sequential instrument use was 20% with a successful trial and 29% with a failed trial. 59% 21% 8% 8% 4% N on descent N on rotation U nable to apply forceps ND C up slipped Documented reasons for failure
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Transcript of TEMPLATE DESIGN © 2008 Outcome of trial of instrumental delivery in theatre Dr Uma Mahesha Arava,...
TEMPLATE DESIGN © 2008
www.PosterPresentations.com
Outcome of trial of instrumental delivery in theatreDr Uma Mahesha Arava, Dr Toli S Onon
University Hospital of South Manchester, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT, England.
Introduction1
Instrumental deliveries account for an estimated 10-15 % of births in the UK 2. The choice of instrument and the experience of the accoucheur have been identified as risk factors for both fetal and maternal morbidity,3,4 and to further improve the safety of instrumental vaginal delivery, the Royal College of Obstetricians and Gynaecologists(RCOG) have issued guidelines which include recommendations for patients who should be managed as a trial of instrumental delivery in theatre, with immediate recourse to Caesarean section when necessary.5
We undertook a retrospective study to look at specific fetal and maternal outcomes associated with instrumental delivery in theatre and also assess factors related to success or failure of instrumental delivery.
Methodology
Data was collected retrospectively utilising theatre records, from all trials of instrumental deliveries in theatre over a 12 month period. 80 women underwent a trial of instrumental delivery and information recorded included parity, gestation, onset of labour, fetal blood sampling, fetal position, presence of caput and moulding, indication for trial, instrument used, use of sequential instruments, reason for failure of instrumental delivery, grade of operator, eventual mode of delivery, perineal tears, cord ph and Apgar scores.
Results
• Of the 56 successful trials, 8 women had 3rd degree perineal tears with a rate of 14%.
• 86% of women who went to theatre for a trial were primiparous.
• Occipito posterior and occipito transverse position were associated with 65% of failed instrumental deliveries.
• There were 7 (9%) cases of Cord arterial ph < 7.1 with 4 and 3 cases when the trial was successful and failed respectively.
• There was 1 instance when the Apgar score was < 7 at 5 minutes (successful trial).
Conclusions
References
In our cohort, the success rate of trial of instrumental delivery in theatre was 70% with a 14% incidence of third degree perineal tears when the trial was successful. Trial of instrumental delivery was more common in primiparous women than multiparous women. Failure was more likely with fetal malposition and failure of descent with traction. Operative vaginal delivery should be abandoned when there is no evidence of descent with moderate traction during each contraction or when delivery is not imminent following three contractions of a correctly applied instrument by an experienced operator.
OPTIONALLOGO HERE
OPTIONALLOGO HERE
1. Olagundoye V, MacKenzie I. The impact of a trial of instrumental delivery in theatre on neonatal outcome. BJOG 2007;114:603–608.
2. Thomas J, Paranjothy S. The National Sentinel Caesarean Section Audit Report. London: RCOG Press, 2001.
3. Johanson R,Menon BKV. Vacuum extraction vs forceps delivery (Cochrane review). In: The Cochrane Library. Oxford, UK: Update software; 1999.
4. RCOG. Operative Vaginal Delivery. Guideline 26, 1–6. London: Royal College of Obstetricians and Gynaecologists, 2000.
5. RCOG. Operative Vaginal Delivery. Guideline 26, 1–13. London: Royal College of Obstetricians and Gynaecologists, 2005.
Objectives
To study the rate of success of instrumental delivery in theatre, rate of sequential instrumental use, rate of third degree perineal tears, cord ph <7.1 and Apgars <7 at 5 minutes.
Results
Success
Success70%
Failure30%
Success
Failure
56 patients underwent successful trial of instrumental delivery with a success rate of 70% and failure rate of 30%.
51
13 8
3 1 1 3
0
10
20
30
40
50
60
1
Prolonged 2nd stage
Pathological CTG
Suboptimal CTG
Suspected fetaldistress
Abruption
Breech
Not.doc.
The most common indication for a trial was failure to progress in the second stage of labour.
• Sequential instrument use was 20% with a successful trial and 29% with a failed trial.
59%21%
8%8% 4% Non descent
Non rotation
Unable to apply forceps
ND
Cup slipped
Documented reasons for failure
