Clinical audit: obstetric performance after caesarean section

Abstract

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.