Background: Second stage caesarean sections following failed instrumental delivery are in rising trend. Maternal and neonatal risks are significantly high following failed instrumental deliveries. Identification of contributing factors is important to modify the success rate of instrumental delivery. The objective of this study was to identify the potential contributing factors for failed instrumental delivery and to assess major maternal and neonatal morbidity associated with such deliveries.
Methods: This retrospective observational study was carried out in the Obstetric Department, St. Richard's Hospital, United Kingdom from 01st December 2011 to 30th April 2012. Data collection was carried out using proforma. Contributing factors were predetermined.
Results: Total number of births during particular period was 2825. There were 44 failed instrumental deliveries out of 275 trials. The overall rate of failed instrumental delivery was 16%. In 54.5% (24 of 44) of cases, consultant was not present physically at the time of delivery. Position of the head was not properly determined in 32% (14 of 44) of cases. Eighteen (41%) deliveries had been carried out by junior doctors (< ST ). Thirty one 3 (70%) of patients had attempted ventouse deliveries. Twenty five (58%) women had primary postpartum haemorrhage and 21% (9) of newborn babies had cord pH < 7.2.
Conclusion: Significant number of failed instrumental deliveries happened due to the lack of consultant involvement, involvement of junior medical staff, failure to determine position of head and more frequent use of ventouse rather than forceps. There were significant major neonatal and maternal morbidities. We recommend structured junior staff training on instrumental delivery with assessment of competencies. Consultant involvement and appropriate use of instruments are important to optimize success rate of instrumental delivery