Evaluation of Operative Vaginal Delivery Practices and Maternal-Neonatal Outcomes.

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Clinical Audit

Background:

• Operative vaginal deliveries (OVDs), including vacuum and forceps-assisted births, are critical interventions for prolonged labor or fetal distress.
• Adherence to clinical guidelines and meticulous documentation are paramount for maternal and neonatal safety during OVDs.
• This audit evaluated OVD practices at Bedford Hospital against Royal College of Obstetricians and Gynaecologists (RCOG) guidelines to identify areas for care enhancement.

Purpose of the Study:

• To assess adherence to RCOG and local guidelines for operative vaginal delivery practices.
• To evaluate maternal and neonatal outcomes associated with operative vaginal deliveries.
• To identify specific areas for improvement in OVD procedures and patient safety.

Main Methods:

• A retrospective audit of 62 women undergoing attempted OVDs between September and December 2024.
• Data extraction from electronic maternity records and NerveCenter, focusing on instrument type, success rates, documentation, and outcomes.
• Audit standards were based on RCOG Green-top Guideline No. 26 and local protocols.

Main Results:

• A procedural success rate of 100% was achieved for all OVDs, with equal use of vacuum and forceps.
• Indications and consent were documented in over 96% of cases; however, areas for improvement included post-procedure debriefing (16.1%), antibiotic prophylaxis (70.9%), and VTE assessment (90.3%).
• Maternal complications included third-degree perineal tears (6.45%) and postpartum hemorrhage (12.9%). Neonatal outcomes were generally favorable, with low rates of special care unit admission and shoulder dystocia.

Conclusions:

• Operative vaginal deliveries in this cohort were performed safely with high success rates and appropriate indications.
• Despite favorable outcomes, rare but significant complications necessitate timely escalation, senior review, and structured debriefing.
• Ongoing audits are essential to optimize maternal and neonatal safety and ensure consistent guideline adherence.