The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

Chart Documentation of Informed Consent for Operative Vaginal Delivery: Is It Adequate?

Authors: Catherine Matthews Nichols, MD, Laura C. Pendlebury, MD, Jamie Jennell

Abstract

Objectives: To determine the documentation frequency of informed consent for women undergoing a trial of nonemergent instrumental delivery.


Study Design: A retrospective chart review of instrumented vaginal deliveries from 1992 to 2005 was performed. Cases were identified from a Labor and Delivery database and hospital records were reviewed for documentation of associated risks, general consent for the procedure, indication, and option of cesarean delivery (CD).


Results: Three hundred forty six charts were reviewed: 246 were excluded for an emergency delivery (19%), misclassification (25%), or lost notes (27%). In the remaining 100 cases, 61% had a general consent for instrumented vaginal delivery. Documentation of any maternal or neonatal risks was found in 3% and 0%, respectively. The option of a cesarean delivery was documented in 22% of the cases. When comparing 5-year time intervals before and after 2000, there was no increased frequency in documentation of maternal or neonatal risks.


Conclusions: Documentation of informed consent for instrumented vaginal delivery is inconsistent and should be improved.


Key Points


* More than one-third of women undergoing an elective trial of instrumental vaginal delivery did not have chart documentation of general consent for the procedure.


* Any maternal and/or neonatal risk of instrumental vaginal delivery was documented in 3% and 0% of charts reviewed, respectively.


* Documentation of the known maternal and/or neonatal risks of instrumental vaginal delivery did not improve over time.


* Documentation of informed consent for instrumental vaginal delivery is inconsistent and should be improved

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References

1. Murphy DJ, Liebling RE, Verity L, et al. Early maternal and neonatal morbidity associated with operative delivery in second stage of labour: a cohort study. Lancet 2001;358:1203–1207.
 
2. Burrows LJ, Meyn LA, Weber AM. Maternal morbidity associated with vaginal versus cesarean delivery. Obstet Gynecol 2004;103:907–912.
 
3. Hannah ME, Hannah WJ, Hewson SA, et al. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial: Term Breech Trial Collaborative Group.Lancet 2000;356:1375–1383.
 
4. Wagner M. Choosing caesarean section. Lancet 2000;356:1677–1680.
 
5. Johanson RB, Menon BK. Vacuum extraction versus forceps for assisted vaginal delivery. Cochrane Database Syst Rev 2000:CD000224.
 
6. Liebling RE, Swingler R, Patel RR, et al. Pelvic floor morbidity up to one year after difficult instrumental delivery and cesarean section in the second stage of labor: a cohort study. Am J Obstet Gynecol 2004;191:4–10.
 
7. Christianson LM, Bovbjerg VE, McDavitt EC, et al. Risk factors for perineal injury during delivery. Am J Obstet Gynecol 2003;189:255–260.
 
8. Kamm MA. Obstetric damage and faecal incontinence. Lancet 1994;344:730–733.
 
9. MacLennan AH, Taylor AW, Wilson DH, et al. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG 2000;107:1460–1470.
 
10. Rortveit G, Daltveit AK, Hannestad YS, et al. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med 2003;348:900–907.
 
11. Johanson RB, Heycock E, Carter J, et al. Maternal and child health after assisted vaginal delivery: five-year follow up of a randomised controlled study comparing forceps and ventouse. Br J Obstet Gynaecol 1999;106:544–549.
 
12. Dupuis O, Silveira R, Dupont C, et al. Comparison of ‘instrument-associated’ and ‘spontaneous’ obstetric depressed skull fractures in a cohort of 68 neonates. Am J Obstet Gynecol 2005;192:165–170.
 
13. Towner D, Castro MA, Eby-Wilkens E, et al. Effect of mode of delivery in nulliparous women on neonatal intracranial injury. N Engl J Med 1999;341:1709–1714.
 
14. Jhawar BS, Ranger A, Steven D, et al. Risk factors for intracranial hemorrhage among full-term infants: a case-control study. Neurosurgery 2003;52:581–590; discussion 588–590.
 
15. Demissie K, Rhoads GG, Smulian JC, et al. Operative vaginal delivery and neonatal and infant adverse outcomes: population-based retrospective analysis. BMJ 2004;329:24–29.
 
16. Johanson RB, Rice C, Doyle M, et al. A randomised prospective study comparing the new vacuum extractor policy with forceps delivery. Br J Obstet Gynaecol 1993;100:524–530.
 
17. Wen SW, Liu S, Kramer MS, et al. Comparison of maternal and infant outcomes between vacuum extraction and forceps deliveries. Am J Epidemiol 2001;153:103–107.
 
18. Perlow JH, Wigton T, Hart J, et al. Birth trauma: a five-year review of incidence and associated perinatal factors. J Reprod Med 1996;41:754–760.
 
19. Gilbert WM, Nesbitt TS, Danielsen B. Associated factors in 1611 cases of brachial plexus injury.Obstet Gynecol 1999;93:536–540.
 
20. Learman LA. Regional differences in operative obstetrics: a look to the South. Obstet Gynecol1998;92:514–519.
 
21. Combs CA, Robertson PA, Laros RK Jr. Risk factors for third-degree and fourth-degree perineal lacerations in forceps and vacuum deliveries. Am J Obstet Gynecol 1990;163:100–104.
 
22. Leeman L, Spearman M, Rogers R. Repair of obstetric perineal lacerations. Am Fam Physician2003;68:1585–1590.
 
23. Fitzpatrick M, Behan M, O’Connell PR, et al. A randomized clinical trial comparing primary overlap with approximation repair of third-degree obstetric tears. Am J Obstet Gynecol 2000;183:1220–1224.
 
24. Buhling KJ, Schmidt S, Robinson JN, et al. Rate of dyspareunia after delivery in primiparae according to mode of delivery. Eur J Obstet Gynecol Reprod Biol 2006;124:42–46.
 
25. MacArthur C, Glazener CM, Wilson PD, et al. Obstetric practice and faecal incontinence three months after delivery. BJOG 2001;108:678–683.
 
26. Sultan AH, Kamm MA, Bartram CI, et al. Anal sphincter trauma during instrumental delivery. Int J Gynaecol Obstet 1993;43:263–270.
 
27. Bofill JA, Rust OA, Schorr SJ, et al. A randomized prospective trial of the obstetric forceps versus the M-cup vacuum extractor. Am J Obstet Gynecol 1996;175:1325–1330.
 
28. Sultan AH, Kamm MA, Hudson CN, et al. Third-degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ 1994;308:887–891.
 
29. Nichols CM, Lamb EH, Ramakrishnan V. Differences in outcomes after third- versus fourth-degree perineal laceration repair: a prospective study. Am J Obstet Gynecol 2005;193:530–534; discussion 534–536.
 
30. Martin JA, Hamilton BE, Sutton PD, et al. Births: final data for 2002. Natl Vital Stat Rep 2003;52:1–113.
 
31. Kenton K, Brincat C, Mutone M, et al. Repeat cesarean section and primary elective cesarean section: recently trained obstetrician-gynecologist practice patterns and opinions. Am J Obstet Gynecol2005;192:1872–1875; discussion 1875–1876.