Comparison of spontaneous versus operative vaginal delivery using Obstetric Quality of Recovery-10 (ObsQoR-10): An observational cohort study

Abstract

Study objective: We aimed to determine whether patient-reported quality of recovery differed between spontaneous and operative vaginal delivery. We also aimed to psychometrically evaluate the Obstetric Quality of Recovery-10 scoring tool (ObsQoR-10) for use in this setting.

Design: Single center observational cohort study.

Setting: Labour and delivery ward at a peripheral general hospital within the United Kingdom, over a 10-month period.

Patients: 123 women delivering via either spontaneous (n = 68) or operative vaginal delivery (n = 55).

Interventions: Women were asked to complete the ObsQoR-10 and global health visual analogue scale (0-100) on postpartum day 1. A convenience sample of consenting parturients delivering via spontaneous or operative vaginal delivery (forceps or vacuum assisted), were included. In total, 123 deliveries were included (68 via spontaneous and 55 via operative vaginal delivery), with no dropouts.

Measurements: Primary outcome was ObsQoR-10 score and secondary outcomes included measures of validity, reliability and feasibility of ObsQoR-10.

Main results: Quality of recovery was better following spontaneous vaginal delivery. ObsQoR-10 scores were 80.2 (95% CI 76.4-83.9) and 72.1 (95% CI 67.3-76.9], (a difference in score of 8.1 [95% CI 2.1-14.0]) following spontaneous and operative vaginal delivery respectively (p = 0.008).

Validity: ObsQoR-10 correlated with global health visual analogue scale score (R = 0.52; p = 0.01) and scores were higher in women requiring <36 h compared to ≥36 h postpartum hospital stay (81.3 (95% CI 77.9-84.7) versus 72.6 (95% CI 67.9-77.2] hours respectively, (a difference in score of 8.7 [95% CI 2.8-14.6]; p = 0.004). Reliability: ObsQoR-10 demonstrated good internal consistency (Cronbach's alpha = 0.82 and inter-item correlation = 0.32) good split-half reliability (Spearman-Brown Prophesy Reliability Estimate = 0.88) and excellent test-re-test reliability (intra-class correlation coefficient of 0.86 [95% CI 0.72-0.93]). Feasibility: All women completed the survey with a median completion time of 2.5 min.

Conclusions: Quality of recovery appears to be better following spontaneous compared to operative vaginal delivery. This study also demonstrates that ObsQoR-10 is a valid and reliable tool for use following these delivery modes.

Keywords: Childbirth; Instrumental; ObsQoR; ObsQoR-10; Operative vaginal delivery; Patient reported outcome measure; Quality of recovery; Recovery; Spontaneous vaginal delivery.