TEMPLATE DESIGN © Objectives Results(Continued) References Methods Audit on outcome of Instrumental Deliveries: Are we doing enough? Authors: Mr. Indranil Dutta 1 MRCOG, Mr. Srinivas Amirchetty 2 MRCOG. 1 Specialist registrar (ST4/Obstetrics & Gynaecology. Currently working as ST5 at Chesterfield Royal Hospital, UK), 2 Consultant, Obstetrician & Gynaecologist. Affiliation: Department of Obstetrics & Gynaecology, Lincoln County Hospital, Greetwell Road, Lincoln. LN2 5QY. United Kingdom 1, 2. To evaluate the current practice of instrumental deliveries at Lincoln County Hospital (district hospital setting) in UK. A quantitative case note audit was performed retrospectively from 1 st Jan to 28 th February 2011 and prospectively from 1 st March to 31 st March Total numbers of instrumental deliveries were 111. Total numbers of notes recovered were 98. There were no exclusion criteria. The data collections were done through case notes & literature search was done. The operative vaginal delivery rates have remained stable at between 10% and 13% in the UK 1. The current practice at Lincoln is showing a decline during these 3 months. SHOs have performed 3.06% of the procedures alone & 3.06% supervised by registrars. Registrars have performed 92.86% of the procedures. Consultants have performed only 1.02% of procedures. Vaginal delivery was achieved in 94.89% subjects and caesarean section was performed in 5.11% subjects for failed instrumental in theatre. Ventouse was used in 42.85% of subjects and forceps used in 57.15% of subjects. In four subjects double instruments were used. On the other hand it increases the cost of trial in theatre, more staff involvement and engagement and delay in delivery time where early delivery could be beneficial as delivery in theatre takes longer time than in room. Rates of instrumental vaginal delivery range from 5% to 20% of all births in industrialised countries. The majority of instrumental vaginal deliveries are conducted in the delivery room, but in a small proportion (2% to 5%), a trial of instrumental vaginal delivery is conducted in theatre with preparations made for proceeding to caesarean section 3. The shortening of duration training as well as reduction of working hours in the United Kingdom has led to obstetrics trainees, being less experienced in conducting instrumental deliveries. Thus, many junior trainees may prefer to conduct relatively uncomplicated instrumental deliveries in theatre 4. The physical presence of consultants during their dedicated labour ward sessions and also during trial of instrumental deliveries is very much essential for reduction of unnecessary interventions like second stage caesarean sections, reduction of number of unnecessary trials in theatre and associated maternal & neonatal morbidity. The major reasons for instrumental deliveries were due to sub-optimal cardiotocograph in 61 subjects and delay in second stage of labour in 43 subjects. Features of poor documentations were mention about (values given in bracket) abdominal examination (53.06%), station (92.85%), caput (94.89%) moulding (92.85%). In 5.11% of subjects there was no mention about Apgar scores. In 80.06% of subjects, consent was taken. In 62.25% of subjects, no proper bladder care was provided. In 87.75% of subjects, there were no major maternal complications. In 4.08% of subjects, no attempts of fetal blood sampling (FBS) were made, while in 5.10% of subjects FBS were correctly attempted expecting delay in delivery in theatre. Out of 98 subjects, 73.46% of deliveries were taken place in the room & 26.54% in the theatre, which was clearly very high. About 21.43% of subjects achieved vaginal birth when taken into theatre for trial. This also proved the need for physical presence and supervision of consultant in labour ward, confirmation of the need for trial in theatre by consultant before attempting and for good training & supervision of junior medical staff. The mentioned rate was high as registrars were clearly worried about failed instrumental deliveries in room due to lack of direct supervision. Results Conclusions Unsuccessful trials are associated with maternal and neonatal morbidity. This will also help to reduce cost & complaints and better for ongoing training of junior medical staffs. We recommend that antenatal classes in all hospitals in UK uniformly involve discussions about expectations and understandings of the expectant mothers & their family members regarding prolonged second stage, different procedures undertaken, pain relief, maternal & neonatal morbidity and complications associated with instrumental deliveries and second stage caesarean sections. These can be verified again in between weeks by medical staffs. 1.Royal College of Obstetricians & Gynaecologists, Green-top guideline No: 26 (Operative vaginal delivery); February Royal College of Obstetricians & Gynaecologists, Consent Advice No: 11; July Majoko F, Gardener G; Trial of instrumental delivery in theatre versus immediate caesarean section for anticipated difficult assisted births. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No: CD DOI: / CD pub2. 4.Ebulue V, Vadalkar J, Cely S, Dopwell F, Yoong W; Fear of failure: are we doing too many trials of instrumental delivery in theatre? Acta Obstet Gynecol Scand. 2008; 87(11):