Clinical audit: obstetric performance after caesarean section. 2003

M Raheem, and M Salloum
Saint Mary's Hospital, Portsmouth, UK. mohamed@raheem786.freeserve.co.uk

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.

UI MeSH Term Description Entries
D010298 Parity The number of offspring a female has borne. It is contrasted with GRAVIDITY, which refers to the number of pregnancies, regardless of outcome. Multiparity,Nulliparity,Primiparity,Parity Progression Ratio,Parity Progression Ratios,Ratio, Parity Progression,Ratios, Parity Progression
D011247 Pregnancy The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH. Gestation,Pregnancies
D002585 Cesarean Section Extraction of the FETUS by means of abdominal HYSTEROTOMY. Abdominal Delivery,Delivery, Abdominal,C-Section (OB),Caesarean Section,Postcesarean Section,Abdominal Deliveries,C Section (OB),C-Sections (OB),Caesarean Sections,Cesarean Sections,Deliveries, Abdominal
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014219 Trial of Labor Allowing a woman to be in LABOR, OBSTETRIC long enough to determine if vaginal birth may be anticipated. Labor Trial,Labor Trials
D017604 Cesarean Section, Repeat Extraction of the fetus by abdominal hysterotomy anytime following a previous cesarean. Repeat Cesarean Section,Cesarean Sections, Repeat,Repeat Cesarean Sections,Section, Repeat Cesarean,Sections, Repeat Cesarean

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