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OSATS, advanced labour ward practice ATSM

This page sets out the OSATS requirements for the advanced labour ward practice 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

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