Room or Theatre?

Postpartum haemorrhage is one of the most common complications of assisted vaginal birth, yet the decision to have a forceps birth in the labour room rather than obstetric theatre often comes down to unit culture or an individual obstetrician's judgement rather than a clear evidence base. Some clinicians take every forceps birth to theatre as a matter of routine, others manage the same cases in the room, and the two approaches persist side by side with little good data on whether the choice of location actually changes the risk of significant bleeding.

TRACE (Theatre versus Room - A Comparison of haemorrhage Events) addresses this by comparing blood loss, in millilitres and as a percentage of estimated blood volume, between 789 assisted vaginal births at NHS Lothian conducted in the labour room and in theatre over a twelve month period. The analysis adjusts for known drivers of bleeding risk, including body mass index, parity, labour duration and the grade of obstetrician performing the delivery, and looks separately at rates of major haemorrhage, high dependency admission and return to theatre by location. The aim is to give obstetric and anaesthetic teams evidence to draw on when deciding where a complex assisted birth should take place.