A Safety Bundle to Reduce Perinatal and Maternal Morbidity from Operative Vaginal Birth.

Abstract

Introduction: Operative vaginal birth (OVB) is associated with higher maternal and perinatal morbidity. A safety bundle, including a structured time-out, procedural checklist and intrapartum ultrasound to confirm fetal position, aims to improve these outcomes. Aim(s): To assess the effectiveness of an OVB safety bundle. Method(s): We performed a prospective cohort study of women with a term singleton cephalic fetus attempting OVB at Monash Health. We compared births where the bundle was and was not used, assessing neonatal and maternal outcomes. To control confounding by indication, we estimated propensity scores (PS) for the probability of using the bundle for each case and adjusted effect estimates for the PS using multivariable logistic regression models. Result(s): There were 996 attempted OVB from August 2022 to June 2023. The bundle was used in 767 births, of which 90% used the checklist, 62% the time-out and 53% intrapartum ultrasound, while in 229 births no aspect of the bundle was used. OVB where the bundle was used were less likely to be performed in the operating theatre, have a consultant present, or not document fetal position or station. Use of the bundle was associated with significantly less neonates delivered in an unexpected position (0.9% vs. 3.5%, adjusted odds ratio (adjOR) 0.23, 95% CI 0.08-0.67, P = 0.008) and a non-significant trend to reduced composite neonatal morbidity (21.6% vs. 27.5%, adj OR 0.79, 95% CI 0.55-1.13, P = 0.197). Discussion(s): Use of a safety bundle for OVB is associated with less infants delivered in an unexpected position and may improve perinatal outcomes.