NMH

86 Maternity and Obstetrics Group 4(a) Caesarean Section Rate by Indication for Induction and Indication for Caesarean Section Fetal reason (no oxytocin) IUA - Inability to treat fetal intolerance IUA - Inability to treat over contracting IUA - Poor response IUA - No oxytocin given EUA - Cephalopelvic disproportion EUA - Persistent malposition Fetal 23/356 (6.5%) 3/351 (0.9%) 8/351 (2.3%) 0/351 (0.0%) 7/351 (2.0%) 3/351 (0.9%) 0/351 (0.0%) 2/351 (0.6%) Maternal 12/300 (4.0%) 4/300 (1.3%) 2/300 (0.7%) 0/300 (0.0%) 1/300 (0.3%) 1/300 (0.3%) 2/300 (0.7%) 2/300 (0.7%) SROM not in labour 7/120 (5.8%) 0/120 (0.0%) 4/120 (3.3%) 0/120 (0.0%) 2/120 (5.3%) 0/120 (0.0%) 0/120 (0.0%) 1/120 (0.8%) Postdates (>40 and less than 42 weeks) 1/71 (1.4%) 1/71 (1.4%) 0/71 (0.0%) 0/71 (0.0%) 0/71 (0.0%) 0/71 (0.0%) 0/71 (0.0%) 0/71 (0.0%) Postterm (>= 42 weeks) 4/62 (6.5%) 0/62 (0.0%) 1/62 (1.6%) 0/62 (0.0%) 2/62 (3.2%) 0/62 (0.0%) 1/62 (1.6%) 0/62 (0.0%) PET/Hypertension 3/43 (7.0%) 0/43 (0.0%) 0/43 (0.0%) 0/43 (0.0%) 2/43 (2.8%) 1/43 (1.4%) 0/43 (0.0%) 0/43 (0.0%) No medical indication 0/38 (0%) 0/38 (0.0%) 0/38 (0.0%) 0/38 (0.0%) 0/38 (0.0%) 0/38 (0.0%) 0/38 0.0%) 0/38 (0.0%) Group 4(a) Outcomes Group 4(a) 2020 2017 2016 2015 2014 2013 2012 2011 2010 ARM 77.1% 759/985 75.6% 84.7% 80.4% 79.9% 83.0% 78.3% 79.4% 76.7% Prostaglandin/Propess 48.8% 481/985 45.8% 34.6% 30.1% 35.0% 37.1% 39.7% 46.8% 42.7% Oxytocin 49.1% 484/985 32.5% 32.1% 30.6% 29.3% 30.9% 30.8% 25.0% 26.6% Epidural 60.7% 598/985 52.0% 51.4% 52.5% 49.8% 51.4% 53.4% 48.2% 47.1% Electronic monitoring 98.7% 972/985 92.5% 90.8% 90.7% 88.5% 87.6% 85.4% 81.2% 78.9% Fetal blood sample 5.7% 56/985 8.0% 6.8% 12.2% 8.2% 8.7% 10.3% 14.0% 8.9% Vaginal operative delivery 5.8% 57/985 5.5% 5.7% 7.6% 4.0% 5.3% 5.7% 4.9% 5.7% Apgars <7 at 5 mins 0.5% 5/985 0.7% 0.8% 0.9% 0.9% 1.3% 0.6% 0.9% 0.8% Cord pH < 7.0 0.0% 0/985 0.5% 0.2% 0.0% 0.0% 0.1% 0.0% 0.1% 0.1% Overall caesarean section rate 5.1% 50/985 4.8% 4.4% 5.7% 5.7% 6.8% 6.0% 5.8% 5.6% Caesarean section at VE=10 0.2% 2/985 0.4% 0.2% 0.7% 0.1% 0.5% 0.3% 0.6% 0.6% Admitted to Neonatal Unit 11.1% 109/985 16.7% 14.4% 12.4% 13.2% 18.3% 11.0% 10.0% 10.4% Episiotomy* 10.3% 101/985 7.9% 8.5% 9.4% 8.2% 9.5% 11.3% 12.2% 13.8% OASIS* 0.6% 6/985 0.5% 1.2% 0.1% 0.7% 0.8% 1.2% 0.6% 0.9% Length of labour >12 hrs 1.3% 13/985 0.6% 0.9% 0.9% 0.3% 0.8% 1.0% 0.4% 0.7% Babies >=4.0kg 25.1% 247/985 25.6% 26.3% 27.1% 30.6% 31.3% 27.9% 28.9% 26.2% Aged >=35 64.4% 634/985 53.4% 52.8% 53.7% 51.0% 48.2% 46.4% 45.9% 45.6% BMI >=30 22.2% 219/985 14.6% 14.4% 14.8% 13.7% 14.9% 17.5% 16.1% 16.5% PPH >1000mls 2.1% 21/985 2.7% 2.7% 1.6% 2.2% 2.6% 1.6% 1.4% 0.4% HIE 0.0% 0/985 0.1% 0.0% 0.0% 0.0% 0.0% 0.1% 0.0% 0.0% Blood transfusion rate 6/985 1.1% 0.0% 1.2% 1.2% 1.5% 1.0% *includes Episiotomy and Sphincter Damage Comment: The incidence of fetal blood sampling has reduced. This may be both due a data quality issue or practice change The incidence of cord pH less than 7.00 recorded as 0 is probably a data quality issue The incidence of caesarean section at VE =10 at 0.2% is a little low and possibly a data quality issue The incidence of oxytocin is higher than previous years and most significant in Groups and 2a and 4a but also in groups 1 and 2. This may indeed show that in previous years the data quality was not so good. The incidence of oxytocin is taken from the medication part of the chart now. The incidence of propess/prostaglandin is similar to nulliparous women. This is clinically unlikely and is probably related to data quality 2020 | NMH Annual Rep t

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