Outcome of trial of instrumental delivery in theatre

1. OPTIONALLOGO HERE Outcome of trial of instrumental delivery in theatre Dr UmaMaheshaArava, Dr Toli S OnonUniversity Hospital of South Manchester, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT, England. OPTIONALLOGO HERE Methodology Results Introduction1 Conclusions 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. 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 informationrecorded 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. • 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). In our cohort, the success rate of trial of instrumental delivery in theatre was 70% with a 14% incidence of third degree perinealtears when the trial was successful. Trial of instrumental delivery was more common in primiparous women than multiparouswomen. Failure was more likely with fetalmalposition 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. Documented reasons for failure Results 56 patients underwent successful trial of instrumental delivery with a success rate of 70% and failure rate of 30%. 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. References OlagundoyeV, MacKenzie I. The impact of a trial of instrumental delivery in theatre on neonatal outcome. BJOG 2007;114:603–608. Thomas J, Paranjothy S. The National Sentinel Caesarean Section Audit Report. London: RCOG Press, 2001. 3. JohansonR,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. • 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.