Fostering Excellence in Obstetrical Surgery.

Area of Science:

• Obstetrics and Gynecology
• Surgical Quality Improvement
• Maternal Healthcare

Background:

• Common obstetrical surgeries are associated with significant maternal outcomes.
• Ensuring quality and safety in these procedures is paramount for patient well-being.
• Variations in non-clinical factors can impact surgical outcomes.

Purpose of the Study:

• To review evidence for quality and safety in common obstetrical surgeries.
• To provide an overview of caesarean delivery, VBAC/TOLAC, operative vaginal delivery, and placenta accreta spectrum.
• To identify quality improvement tools and implementation strategies for obstetrical surgery.

Main Methods:

• A focused scoping review methodology was employed.
• Articles were systematically identified and included for each specific surgery.
• The review synthesized evidence related to quality and safety considerations.

Main Results:

• An overview of caesarean delivery, vaginal birth after caesarean delivery (VBAC)/trial of labor after caesarean delivery (TOLAC), operative vaginal delivery, and placenta accreta spectrum (PAS) was generated.
• Considerations for quality and safety, including non-clinical human factors, were analyzed.
• Quality improvement (QI) tools, implementation cohorts, and strategies addressing barriers were discussed.

Conclusions:

• Healthcare systems and providers must implement evidence-based, "bottom-up/top-down" processes for obstetrical surgery quality and safety.
• Patient demand for quality and safety necessitates proactive implementation.
• Proactive measures reduce the need for legal intervention in ensuring safe obstetrical care.