Labour Management in Trial of Labour After Cesarean Delivery (TOLAC): A Gap Analysis and Quality Improvement Initiative
| Autor: | Emily Delpero, Jacqueline Thomas, Evan Tannenbaum |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Quality management Vaginal birth Chorioamnionitis 03 medical and health sciences 0302 clinical medicine Interquartile range Pregnancy Medicine Humans 030212 general & internal medicine Prospective Studies Cesarean delivery Prospective cohort study reproductive and urinary physiology 030219 obstetrics & reproductive medicine Labor Obstetric business.industry Obstetrics Cesarean Section Trial of labour Obstetrics and Gynecology Surgical Injury medicine.disease Quality Improvement Vaginal Birth after Cesarean Trial of Labor Female business |
| Zdroj: | Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC. 43(8) |
| ISSN: | 1701-2163 |
| Popis: | Objective This quality improvement (QI) initiative was designed to identify gaps between evidence-based or hospital recommendations for trial of labour after cesarean delivery (TOLAC) labour management and clinical practice. Methods Viable, singleton pregnancies from January 1, 2016, to December 31, 2018, undergoing TOLAC were extracted from the electronic medical record. Sixty randomly selected charts were reviewed for (1) consent, (2) induction methods, (3) oxytocin use, (4) continuous fetal monitoring, (5) admission indication, (6) examination regularity, (7) duration of dystocia before decision to perform cesarean delivery (CD), and (8) maternal complications. Results The institutional vaginal birth after cesarean rate was 71%. Documented consent to TOLAC on admission was present in 50% of cases. Oxytocin augmentation was used in 38% of cases, and the median maximum dose was 4 mU/min (interquartile range [IQR] 3–7.5 mU/min). Delays in initiating oxytocin were identified in 47% of those patients. Decisions to deliver by cesarean were made after a median time of 5 hours and 40 minutes (IQR 3 hours and 30 minutes to 6 hours and 35 minutes) of failure to progress despite adequate contractions. After this decision, median time to delivery was 1 hour and 11 minutes (IQR 57 minutes to 2 hours and 16 minutes). Complications included postpartum hemorrhage (5%) and chorioamnionitis (6.7%). Surgical injury occurred in 10% of intrapartum CD. Peripartum complications were associated with delay in oxytocin implementation (χ2 (1) = 9.80; P Conclusion Areas for QI were identified in (1) consent, (2) duration of dystocia before decision to proceed with CD and delay to CD, and (3) peripartum complications. We recognize the potential use of this as a tool to identify areas for QI and prospective study. |
| Databáze: | OpenAIRE |
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