Consent Practices for Assisted Vaginal Births (AVB) at Two Tertiary Care Hospitals: A Retrospective Review of Physician Documentation |
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| Affiliation: | 1. Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON;2. Temerty Faculty of Medicine, University of Toronto, Toronto, ON;3. Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON;4. Department of Obstetrics and Gynecology, St. Michael’s Hospital, Toronto, ON;1. Department of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan;2. Department of Dermatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan;1. Department of Obstetrics and Gynecology, Atatürk Training and Research Hospital, University of Katip Çelebi, Izmir, Turkey;2. Department of Obstetrics and Gynecology, Izmir Private Can Hospital, Izmir, Turkey;3. Department of Obstetrics and Gynecology, Atatürk Training and Research Hospital, University of Katip Çelebi, Izmir, Turkey;4. Department of Obstetrics and Gynecology, University of Muğla Sıtkı Kocaman, Mugla, Turkey;1. Dept. of Obstetrics, Charité University Hospital, Berlin, Germany;2. Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany;3. Berlin Institute of Health (BIH), Berlin, Germany;4. Prenatal Zurich, Zürich, Switzerland, and Medical Faculty, Heinrich Heine University, Düsseldorf, Germany |
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| Abstract: | ObjectiveTo determine whether assisted vaginal birth (AVB) consent documentation, a surrogate for in vivo consent, aligns with Canadian practice guidelines at 2 Canadian tertiary-level obstetric centres.MethodsThis was a retrospective review of AVBs (vacuum and forceps) from July 2019 to December 2019 at 2 tertiary-level hospitals with template-based (Site 1) or dictation-based (Site 2) documentation. We extracted, from obstetric and neonatal charts, AVB type, physician and documenter types (resident/fellow/family doctor/generalist obstetrics and gynecology [OBGYN]/maternal-fetal medicine), and consent elements (present/absent) based on a predetermined checklist. Data were summarized and comparisons were made using chi-square test, Fisher exact test, and logistic regression, where appropriate.ResultsWe identified 551 AVBs (156 forceps, 395 vacuum) with most documentation completed by generalist OBGYNs or residents (333/551, 60.5%). Most vacuum-assisted deliveries documented no specific maternal (366/395, 92.7%) or neonatal (364/395, 92.2%) risks, and 107/156 (68.6%) and 106/156 (67.9%) forceps-assisted deliveries lacked specific documentation of maternal and neonatal risk, respectively. At Site 2, postpartum hemorrhage risk at vacuum-assisted deliveries was more commonly documented (6/90 [6.7%] vs. 2/395 [0.7%], P = 0.002) as was at least 1 neonatal risk and risk of obstetrical anal sphincter injury at forceps-assisted deliveries (50/133 [37.6%] vs. 0/23 [0%], P < 0.001) and (43/133 [32.3%] vs. 0/23 [0%], P = 0.001), respectively.ConclusionsOpportunity to improve AVB consent documentation exists, warranting quality improvement initiatives. |
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| Keywords: | informed consent documentation obstetrical forceps vacuum extraction obstetrical |
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