Clinical audit: obstetric performance after caesarean section.
The RCOG Clinical Audit Unit has defined two auditable standards in women labouring with a previous caesarean section (LSCS). We found documentation of a discussion in 98% of patient notes on issues relating to delivery, including a trial of vaginal delivery. Excluding patients declining a trial of vaginal delivery, the successful vaginal delivery rate was 36/60 (60%). One in three patients, although suitable, declined a trial of vaginal delivery. This request was invariably made at the booking consultation. Two in three patients required a repeat LSCS for delivery. Women were twice and 2.4 times as likely to have a repeat LSCS delivery when their primary LSCS was for fetal distress and failure to progress, respectively. There was one (1%) case of confirmed scar rupture and one stillbirth of unknown aetiology at 34/40. Recommendations include vigilance and senior supervision at primigravid labours and confident recommendation of trial of vaginal delivery by obstetrics team.
Raheem
M
M
Saint Mary's Hospital, Portsmouth, UK. mohamed@raheem786.freeserve.co.uk
Salloum
M
M
D002585:Cesarean Section; D017604:Cesarean Section, Repeat; D005260:Female; D006801:Humans; D010298:Parity; D011247:Pregnancy; D014219:Trial of Labor