OSATS, advanced labour ward practice (2018) ATSM Skip to main content

OSATS, advanced labour ward practice (2018) ATSM

OSATS requirements for the advanced labour ward practice (2018) ATSM

You need to be competent in:

Rotational instrumental delivery

Items under observation:

  • Ensuring appropriate selection of patient including fetal size and wellbeing, uterine contractility and amount of head palpable
  • Vaginal assessment - correct determination of position and station of the vertex, and size of the pelvis to assess disproportion
  • Appropriate place of delivery
  • Appropriate communication with team
  • Appropriate counselling and consent
  • Appropriate preparation, including analgesia and bladder care
  • Selection of appropriate instrument
  • Safe application of instrument
  • Successful rotation
  • Appropriate traction and safe delivery of head
  • Safe completion of delivery
  • Perineal repair
  • Appropriate abandoning of procedure
  • Section following failed trial
  • Appropriate debrief and counselling

Cervical cerclage

Items under observation:

  • Appropriate patient selection
  • Ensuring patient and accompanying partner understand procedure
  • Appropriate transfer of patient to theatre and positioning
  • Ensuring adequate analgesia
  • Shows knowledge of and assembles required instruments
  • Preoperative swab, instrument and needle check
  • Systematic examination: cervical length, dilatation
  • Use of foley catheter balloon if appropriate
  • Appropriate choice of suture
  • Appropriate handling of the cervix
  • Appropriate insertion of suture
  • Appropriate placement of knot
  • Clear documentation including postoperative plan
  • Debriefing of patient and partner
  • Appropriate use of team

External cephalic version in labour

Items under observation:

  • Ensure appropriate selection of patient
  • Use of tocolysis if appropriate
  • Appropriate preparation
  • Careful ultrasound assessment of fetal and placental position, liquor and identification of body parts
  • Safe and systematic movement of fetus
  • Regular assessment of fetal wellbeing during procedure
  • Ensuring no excessive maternal discomfort
  • Ensuring fetal monitoring post procedure
  • Checking appropriate follow-up arrangements

Manual rotation

Items under observation:

  • Appropriate patient selection
  • Ensuring patient and accompanying partner understand procedure
  • Ensuring adequate analgesia
  • Ensuring empty bladder
  • Systematic abdominal and vaginal examination: engagement, position, station, caput, moulding, descent with contraction, pelvic size and shape
  • Flexion of head between contractions
  • Confirmation of position post-procedure
  • Assessing need for operative vaginal delivery
  • Awareness of maternal and fetal wellbeing throughout
  • Communication with woman and partner throughout
  • Debriefing of woman following procedure
  • Appropriate use of team
  • Documentation

Vaginal breech delivery

Items under observation:

  • Ensuring patient and accompanying partner understand procedure
  • Appropriate assessment of maternal wellbeing
  • Appropriate assessment of fetal wellbeing
  • Ensuring adequate analgesia
  • Ensuring experienced help is available (including paediatrician) and that the instrumental delivery trolley is within the delivery room
  • Hand washing, sterility
  • Appropriate positioning, cleansing and draping of patient at the appropriate time
  • Considers/performs catheterisation
  • Vaginal examination: (dilatation, position, station, descent with contraction, pelvic size and shape)
  • Collaboration with midwife and patient to coordinate maternal effort
  • Consideration/performance of episiotomy (timing/size/position)
  • ‘Hands off the breech’ approach, but considers gentle manipulation of the fetus into a sacro-anterior position during pushing if required.
  • Delivery of body and legs – minimising manipulation
  • Delivery of the arms – awareness of landmarks, potential problems and appropriate action
  • Delivery of the head – awareness of landmarks, potential problems and appropriate action
  • Initial care of the baby, including cord
  • Delivery of placenta and membranes
  • Checking for uterine laxity and perineal/vaginal trauma
  • Perineal repair
  • Debriefing patient and partner
  • Postpartum plan and documentation
  • Using team well and communicating effectively

Elsewhere on the site

OSATS
An explanation of OSATS: what they are and how they are used within O&G training
Resources for trainees
Resources to support specialty trainees in O&G