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Obstetric Trauma: Clinical and System Reviews, Incident Analyses

Given the broad range of potential causes of complications from obstetric trauma, clinical and system reviews should be conducted to identify latent causes and determine appropriate recommendations.

Occurrences of harm are often complex with many contributing factors. Organizations need to:

1. Measure and monitor the types and frequency of these occurrences.
2. Use appropriate analytical methods to understand the contributing factors.
3. Identify and implement solutions or interventions that are designed to prevent recurrence and reduce risk of harm.
4. Have mechanisms in place to mitigate consequences of harm when it occurs.

To develop a more in-depth understanding of the care delivered to patients, chart audits, incident analyses and prospective analyses can be helpful in identifying quality improvement opportunities. Links to key resources forÌýconducting chart auditsÌý²¹²Ô»åÌýanalysis methodsÌýare included in theÌýHospital Harm Improvement Resources Introduction.

If your review reveals that your cases of OB Trauma are related linked to specific processes or procedures, you may find these resources helpful:

• American College of Obstetricians and Gynecologists (ACOG).Ìý
• Prevention and Management of Obstetric Lacerations at Vaginal Delivery. ACOG Practice Bulletin, Clinical Management Guidelines for Obstetrician–Gynecologists. Number 198, September 2018.
• Operative Vaginal Delivery. ACOG Practice Bulletin, Clinical Management Guidelines for Obstetrician–Gynecologists. Number 154, November 2015.
• Vaginal Birth After Cesarean Delivery. ACOG Practice Bulletin, Clinical Management Guidelines for Obstetrician–Gynecologists. Number 2015, February 2019. Ìý
• Association of Women's Health, Obstetric and Neonatal Nurses.
• Association of Ontario Midwives.Ìý

• Vaginal birth after Previous Low-Segment Caesarean Section, Clinical Practice Guideline, 14. September 2011.

• Ontario Health.Ìý

• Vaginal Birth After Caesarean: (VBAC)-Quality Standard-

• National Institute for Health and Care Excellence (NICE).Ìý

• Intrapartum care for healthy women and babies. Clinical guideline 190. Published date: December 2014, Last updated: February 2017.Ìý
• Caesarean section. Clinical guideline 132. Published date:Ìý November 2011 Last updated: September 2019.

• Royal College of Obstetricians and Gynaecologists (RCOG).Ìý

• The OASI Care Bundle Project-
• The Management of Third- and Fourth-Degree Perineal Tears- Green-top Guideline No. 29, June 2015
• Birth After Previous Caesarean Birth-Green-top Guideline No. 45, October 2015

• Society of Obstetricians and Gynaecologists of Canada (SOGC).Ìý

• Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair.Ìý SOGC Clinical Practice Guideline. No. 330, December 2015.
• Assisted Vaginal Birth. SOGC Clinical Practice Guideline. No. 381, June 2019.
• Trial of Labour After Caesarean. SOGC Clinical Practice Guideline. No. 382, July 2019.

• World Health Organization (WHO).Ìý

• WHO Safe Childbirth Checklist.Ìý

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