Background Adhering to standards of safe clinical practice in Operative vaginal delivery helps minimise risk of morbidity and likelihood of litigation without limiting maternal choice. Setting East Lancashire Hospitals Maternity Unit. Methodology Review of 150 consecutive cases of OVD (operative vaginal delivery) identified through Athena in 2009 (75 in room,75 in theatre). Results 76% were primigravida. 18.6% were low risk on midwife led care who could have potentially given birth at home or birthing centre risking intrapartum transfer. Documentation regarding consent was noted in 97.3% of OVD in theatre and only 17.3% of OVD in room. This was absent in 44% overall and 2.7% of theatre OVD. Documentation on analgesia was absent in 6.6%, Position of head not stated in 18.6%, Sequential instruments used in 12.6%, 92% had episiotomy or perineal tear with 2.6% having third degree tear. Failure rate was 8.6% overall, with nil failure in room and 17.3% in theatre. Cord gases were not performed or inappropriate (only venous) in 16.6% with 4% babies having arterial PH<7.1. Documentation regarding incident reporting was missing although 21.3% fulfilled maternity trigger list criteria. Conclusion and Recommendations Scope for improvement in standards of safe clinical practice was highlighted in all areas. Continuous audit of OVD has since been implemented within the unit. All OVD cases are discussed at case review meetings at shift changes three times daily since November 2009. Areas of deficiency are identified and rectified immediately, reducing likelihood of risk recurrence through this strategy of team based reflection and proactive risk management.

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Background Adhering to standards of good clinical practice following Operative vaginal delivery helps minimise risk of physical and physocological morbidity to mother. Setting East Lancashire Hospitals Maternity Unit. Methodology Review of 150 consecutive cases of OVD (operative vaginal delivery) identifi ed through Athena in 2009. ResultsFour key areas of care were analysed: post procedure pain relief, bladder care, Thromboprophylaxis and debriefi ng consultation. 62% had postprocedure analgesia with diclofenac and paracetamol while 21% received other analgesics. 10% received no analgesia while 6.6% had no documentation regarding pain relief. Volume of fi rst void was documented only in 3.3%, with time of fi rst void noted in 20%. Documentation on bladder care was absent in 50.6% and fl uid balance chart was seen only in 2.6%. 30.6% had indwelling catheter but only 18.6% had catheter left in for at least 12 h as recommended. Thrombo-prophylaxis Risk assessment was noted in 39.3%, but only 22% received prophylaxis. 99.3% stayed ≥1 day with 49.3% staying in ≥2 days. Debriefi ng occurred in 11.3%. However only 1.3% (two women) were debriefed regarding indication and none regarding impact of OVD on future deliveries. Conclusion and Recommendations Scope for improvement in standards of care after OVD was highlighted in all areas. Continuous audit of OVD has since been implemented within the unit and guidelines revised. All OVD cases are discussed at case review meetings daily since November 2009. Areas of defi ciency in after care are identifi ed and rectifi ed immediately, through this strategy of team based refl ection and proactive risk management.