Evaluation of Operative Vaginal Delivery Practices and Maternal-Neonatal Outcomes

Background Operative vaginal deliveries (OVDs), including vacuum and forceps-assisted births, are essential interventions for prolonged second-stage labor or fetal compromise. Despite declining global rates, adherence to clinical guidelines and proper documentation remains crucial for maternal and neonatal safety. This audit aimed to evaluate operative vaginal delivery practices at Bedford Hospital, including adherence to Royal College of Obstetricians and Gynaecologists (RCOG) and local guideline recommendations and associated maternal and neonatal outcomes. The audit also aimed to identify areas for improvement to enhance patient safety and quality of care. Methodology A retrospective audit included all women (n = 62) undergoing attempted OVDs from September to December 2024. Data were extracted from electronic maternity records and NerveCenter, assessing instrument type, success rate, decision-to-delivery interval, documentation (consent, indication, debrief), consultant presence, antibiotic and venous thromboembolism (VTE) prophylaxis, maternal complications, and neonatal outcomes. Audit standards were based on RCOG Green-top Guideline No. 26 and local protocols. Results Monthly OVD rates ranged from 9/225 (4%) in September, 16/211 (7.58%) in October, 25/198 (12.6%) in November, to 12/224 (5.36%) in December, with a total of 62/858 (7.2%) OVDs and a 100% procedural success rate. Indications for instrumental delivery were documented in 60/62 (96.8%) cases, and consent was documented in 96.8% of cases, either written (for theatre deliveries) or verbal (for delivery-suite births). Vacuum and forceps were used equally (29/62, 46.8% each), with 4/62 (6.4%) sequential instrument cases. Registrars performed 57/62 (91.9%) deliveries, with consultants present in 22/62 (35.5%) cases. Maternal outcomes included 4/62 (6.45%) third-degree perineal tears and 8/62 (12.9%) cases of blood loss >1,000 mL, including 2/62 (3.2%) massive obstetric hemorrhages (1,940-2,200 mL). Neonatal outcomes were generally favorable, with 2/62 (3.2%) special care baby unit admissions, 4/62 (6.5%) shoulder dystocia events, and 2/62 (3.2%) low APGAR scores (<5 at birth or <7 at five minutes). Areas for improvement were identified in post-procedure debriefing (10/62, 16.1%), antibiotic prophylaxis (44/62, 70.9%), and postnatal VTE assessment (56/62, 90.3%). Conclusions OVDs in this cohort were performed safely with high success rates and appropriate indications. Rare but significant complications highlight the need for timely escalation, senior review, structured debriefing, and ongoing audit to optimize maternal and neonatal safety and maintain guideline adherence.