Guideline No. 441: Antenatal Fetal Health Surveillance.

OBJECTIVE: To summarize the current evidence and to make recommendations for antenatal fetal health surveillance (FHS) to detect perinatal risk factors and potential fetal decompensation in the antenatal period and to allow for timely intervention to prevent perinatal morbidity and/or mortality. TARGET POPULATION: Pregnant individuals with or without maternal, fetal, or pregnancy-associated perinatal risk factors for antenatal fetal decompensation. OPTIONS: To use basic and/or advanced antenatal testing modalities, based on risk factors for potential fetal decompensation. OUTCOMES: Early identification of potential fetal decompensation allows for interventions that may support fetal adaptation to maintain well-being or expedite delivery. BENEFITS, HARMS, AND COSTS: Antenatal FHS in pregnant individuals with identified perinatal risk factors may reduce the chance of adverse outcomes. Given the high false-positive rate, FHS may increase unnecessary interventions, which may result in harm, including parental anxiety, premature or operative birth, and increased use of health care resources. Optimization of surveillance protocols based on evidence-informed practice may improve perinatal outcomes and reduce harm. EVIDENCE: Medline, PubMed, Embase, and the Cochrane Library were searched from inception to January 2022, using medical subject headings (MeSH) and key words related to pregnancy, fetal monitoring, fetal movement, stillbirth, pregnancy complications, and fetal sonography. This document represents an abstraction of the evidence rather than a methodological review. VALIDATION METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE: All health care team members who provide care for or education to obstetrical patients, including maternal fetal medicine specialists, obstetricians, family physicians, midwives, nurses, nurse practitioners, and radiologists. SUMMARY STATEMENTS: RECOMMENDATIONS.

Directive clinique no 441 : Surveillance prénatale du bien-être fœtal.

OBJECTIF: Résumer les données probantes actuelles et formuler des recommandations pour la surveillance prénatale du bien-être fœtal afin de détecter les facteurs de risque périnatal et toute potentielle décompensation fœtale et de permettre une intervention rapide en prévention de la morbidité et la mortalité périnatales. POPULATION CIBLE: Personnes enceintes avec ou sans facteurs maternels, fœtaux ou gravidiques associés à des risques périnataux et à la décompensation fœtale. OPTIONS: Utiliser des examens prénataux par technologie de base et/ou avancée en fonction des facteurs de risque de décompensation fœtale. RéSULTATS: La reconnaissance précoce de toute décompensation fœtale potentielle permet d'intervenir de façon à favoriser l'adaptation fœtale pour maintenir le bien-être ou à accélérer l'accouchement. BéNéFICES, RISQUES ET COûTS: Chez les personnes enceintes ayant des facteurs de risque périnatal confirmés, la surveillance du bien-être fœtal contribue à réduire le risque d'issue défavorable. Compte tenu du taux élevé de faux positifs, la surveillance du bien-être fœtal peut augmenter le risque d'interventions inutiles, ce qui peut avoir des effets nuisibles, dont l'anxiété parentale, l'accouchement prématuré ou assisté et l'utilisation accrue des ressources de soins de santé. L'optimisation des protocoles de surveillance d'après des pratiques fondées sur des données probantes peut améliorer les issues périnatales et réduire les effets nuisibles. DONNéES PROBANTES: Des recherches ont été effectuées dans les bases de données Medline, PubMed, Embase et Cochrane Library, de leur création jusqu'à janvier 2022, à partir de termes MeSH et de mots clés liés à la grossesse, à la surveillance fœtale, aux mouvements fœtaux, à la mortinaissance, aux complications de grossesse et à l'échographie fœtale. Le présent document est un résumé des données probantes et non pas une revue méthodologique. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations Assessment, Development and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CONCERNéS: Tous les membres de l'équipe de soins qui prodiguent des soins ou donnent de l'information aux patientes en obstétrique, notamment les spécialistes en médecine fœto-maternelle, les obstétriciens, les médecins de famille, les sages-femmes, les infirmières, les infirmières praticiennes et les radiologistes. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.

Committee Opinion No. 415: Impacted Fetal Head, Second-Stage Cesarean Delivery.

OBJECTIVE: To review the most effective clinical approaches to disengage an impacted fetal head during cesarean delivery. TARGET POPULATION: Women who undergo cesarean delivery of an infant with a deeply impacted head. OPTIONS: The "push" technique (from below) or the "pull" technique (reverse breech extraction). OUTCOMES: Proper management of this clinical scenario can reduce maternal and perinatal morbidity and mortality. BENEFITS, HARMS, AND COSTS: Using an evidence-informed approach when an impacted fetal head is anticipated has the potential to reduce maternal and fetal complications and short- and long-term harm and their associated costs. Research into the value of simulation learning, regular labour assessments, and team preparedness for possible interventions will help inform quality care. EVIDENCE: The following search terms were entered into PubMed/Medline, Google Scholar, and Cochrane for the publication period 2012-2019: • 'Guidelines' 'manual' • 'Caesarean Section' • 'full dilation' • 'operative delivery' • 'impacted head' • 'Caesarean' AND 'full dilation' AND 'impacted head' • 'Caesarean' AND 'second stage of labour' OR 'second stage' AND 'impacted head' • 'Caesarean' OR 'operative delivery' AND 'impacted head' A total of 32 articles were retrieved and 24 were deemed appropriate to include as references. Many of these articles represented expert opinion. Randomized controlled trials had small sample sizes and were conducted in settings that limit the generalizability of their findings to the Canadian population.20 INTENDED USERS: Intrapartum health care providers.

Opinion de comité n° 415 : Césarienne au deuxième stade avec enclavement de la tête fœtale.

OBJECTIF: Passer en revue les stratégies cliniques les plus efficaces pour désengager une tête fœtale enclavée pendant la césarienne. POPULATION CIBLE: Les femmes qui subissent une césarienne lorsque la tête fœtale est fortement enclavée. OPTIONS: La technique par poussée (par le bas) ou par traction (grande extraction du siège par voie abdominale). RéSULTATS: La prise en charge adéquate de cette situation clinique peut réduire les risques de morbidité et mortalité maternelle et périnatale. BéNéFICES, RISQUES ET COûTS: Lorsque l'on anticipe un enclavement de la tête fœtale, il est possible de réduire le risque de complications maternelles et fœtales, les atteintes à court et à long terme ainsi que les coûts associés en adoptant une stratégie fondée sur des données probantes. Les recherches sur la valeur de l'apprentissage par simulation, les évaluations régulières pendant le travail et la préparation de l'équipe aux interventions possibles aideront à orienter les soins de qualité. DONNéES PROBANTES: Les termes de recherche suivants ont été utilisés dans les bases de données PubMed-Medline, Google Scholar et Cochrane pour la période de publication de 2012 à 2019 : • "Guidelines" "manual" • "Caesarean Section" • "full dilation" • "operative delivery" • "impacted head" • "Caesarean" AND "full dilation" AND "impacted head" • "Caesarean" AND "second stage of labour" OR "second stage" AND "impacted head" • "Caesarean" OR "operative delivery" AND "impacted head" Au total, 32 articles ont été récupérés et 24 ont été jugés adéquats comme références. Plusieurs de ces articles étaient des opinions d'experts. Les essais cliniques randomisés avaient des échantillons de petite taille et ont été menés dans des contextes qui limitent la généralisabilité de leurs résultats à la population canadienne20. PROFESSIONNELS CIBLES: Fournisseurs de soins de santé intrapartum.

No. 396-Fetal Health Surveillance: Intrapartum Consensus Guideline.

OBJECTIVE: To present evidence and recommendations regarding use, classification, interpretation, response, and documentation of fetal surveillance in the intrapartum period and to provide information to help minimize the risk of birth asphyxia while maintaining the lowest possible rate of obstetrical intervention. INTENDED USERS: Members of intrapartum care teams, including but not limited to obstetricians, family physicians, midwives and nurses, and their learners TARGET POPULATION: Intrapartum women OPTIONS: All methods of uterine activity assessment and fetal heart rate surveillance were considered in developing this document. OUTCOMES: The impact, benefits, and risks of different methods of surveillance on the diverse maternal-fetal health conditions have been reviewed based on current evidence and expert opinion. No fetal surveillance method will provide 100% detection of fetal compromise; thus, all FHS methods are viewed as screening tests. As the evidence continues to evolve, caregivers from all disciplines are encouraged to attend evidence-based Canadian educational programs every 2 years. EVIDENCE: Literature published between January 1976 and February 2019 was reviewed. Medline, the Cochrane Database, and international guidelines were used to search the literature for all studies on intrapartum fetal surveillance. VALIDATION METHODS: The principal and contributing authors agreed to the content and recommendations. The Board of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The level of evidence has been determined using the criteria and classifications of the Canadian Task Force on Preventive Health Care. BENEFITS, HARM, AND COSTS: Consistent interdisciplinary use of the guideline, appropriate equipment, and trained professional staff enhances safe intrapartum care. Women and their support person(s) should be informed of the benefits and harms of different methods of fetal health surveillance. RECOMMENDATIONS: CommunicationSupport During Active LabourPrinciples of Intrapartum Fetal SurveillanceSelecting the Method of Fetal Heart Rate Monitoring: Intermittent Auscultation or Electronic Fetal MonitoringPaper SpeedAdmission AssessmentsEpidural AnalgesiaIntermittent Auscultation in LabourElectronic Fetal Monitoring in LabourClassification of Intrapartum Fetal SurveillanceMaternal Heart RateFetal Health Surveillance Assessment in the Active Second Stage of LabourIntrauterine ResuscitationDigital Fetal Scalp StimulationFetal Scalp Blood SamplingUmbilical Cord Blood GasesDocumentationFetal Surveillance Technology Not RecommendedFetal Health Surveillance Education.

No396 - Surveillance du bien-être fœtal : Directive clinique de consensus des soins intrapartum.

OBJECTIF: La présente directive fournit des données probantes et des recommandations relativement à la surveillance fœtale en période intrapartum par rapport à son utilisation, à sa classification, à son interprétation, aux réactions du fournisseur de soins et à l'inscription des données de surveillance. Cette directive vise à fournir les renseignements qui peuvent potentiellement limiter le risque d'asphyxie du nouveau-né tout en maintenant les interventions obstétricales au plus bas taux possible. UTILISATEURS CONCERNéS: Les membres de l'équipe de soins intrapartum, y compris, notamment, les obstétriciens, les médecins de famille, les sages-femmes, les infirmières et leurs apprenants. POPULATION CIBLE: Femmes en période intrapartum. OPTIONS: Toutes les méthodes d'évaluation de l'activité utérine et de surveillance de la fréquence cardiaque fœtale ont été prises en compte dans l'élaboration du présent document. RéSULTATS: Les conséquences, bienfaits et risques des différentes méthodes de surveillance sur la variété d'états de santé fœto-maternelle ont fait l'objet d'évaluations fondées sur les données probantes actuelles et l'opinion de spécialistes. Aucune méthode de surveillance fœtale n'offre une détection infaillible de tout danger pour le fœtus; ainsi, toutes les méthodes de SBEF sont considérées comme des tests de dépistage. Étant donné que les données probantes évoluent continuellement, les fournisseurs de soins, toutes disciplines confondues, sont encouragés à suivre tous les deux ans un programme de formation canadien fondé sur des données probantes. DONNéES PROBANTES: La littérature publiée entre juin 1976 et février 2019 a été passée en revue. Les bases de données Medline et Cochrane ainsi que les directives internationales ont été utilisées afin de chercher dans la littérature toutes les études sur la surveillance fœtale intrapartum. MéTHODES DE VALIDATION: Le contenu et les recommandations ont été approuvés par les auteurs principaux et collaborateurs. Le conseil d'administration de la Société des obstétriciens et gynécologues du Canada a approuvé la version définitive aux fins de publication. La qualité des résultats a été déterminée au moyen des critères et des catégories établis par le Groupe d'étude canadien sur les soins de santé préventifs. AVANTAGES, PRéJUDICE ET COûTS: L'utilisation interdisciplinaire cohérente de la présente directive, l'équipement adéquat et le personnel compétent améliorent la sécurité des soins intrapartum. Il convient d'informer les femmes et leurs personnes de soutien des bienfaits et des préjudices inhérents aux différentes méthodes de surveillance du bien-être fœtal. RECOMMANDATIONS: Communication Soutien durant la phase active du travail Principes de surveillance fœtale intrapartum Choix de la méthode de surveillance de la fréquence cardiaque fœtale : auscultation intermittente ou surveillance électronique fœtale Vitesse de déroulement du papier Évaluation d'admission Anesthésie péridurale Auscultation intermittente pendant le travail Surveillance électronique fœtale pendant le travail Classification de la surveillance fœtale intrapartum Fréquence cardiaque maternelle Évaluation de la surveillance du bien-être fœtal à la phase active du deuxième stade du travail Réanimation intra-utérine Stimulation digitale du cuir chevelu fœtal Prélèvement de sang au cuir chevelu fœtal Gazométries du cordon ombilical Données à consigner Technologies de surveillance fœtale non recommandées à l'heure actuelle Formation en surveillance du bien-être fœtal.

Prioritizing Maternal Sepsis: National Adoption of an Obstetric Early Warning System to Prevent Morbidity and Mortality.

Sepsis is one of the leading causes of maternal morbidity and mortality. Analyses have determined that delays in early recognition and prompt initiation of appropriate management are key contributing factors in maternal sepsis deaths. Recent cases of sepsis-related maternal morbidity and mortality across Canada have highlighted the urgent need for a national standardized approach to the detection and treatment of maternal sepsis. The SOGC has established a national multidisciplinary maternal sepsis task force to address this priority. The adoption of a national modified obstetric early warning system (MEOWS) is recommended as a key first step. This early warning scoring (EWS) system will facilitate early detection of maternal clinical deterioration and mandate timely escalation of care appropriate for the severity of illness. There is currently limited use of EWSs in Canada. Introducing a national EWS and a standardized maternal sepsis management guideline provides a tremendous opportunity to improve maternal care. A standardized approach will facilitate future evidence-based evaluation and refinement of the tool, and enable the reduction of preventable maternal morbidity and mortality from sepsis, as well as all causes duplicated.

Exploring Faculty Perceptions of Competency-Based Medical Education and Assessing Needs for Implementation in Obstetrics and Gynaecology Residency.

OBJECTIVE: The shift to competency-based medical education (CBME) is associated with changes in the way residents are taught and assessed. Although there are many purported benefits of CBME, an understanding of the preparedness of faculty to meet the needs of this new paradigm is lacking. The aim of this study was to characterize faculty needs to support the transition to CBME. METHODS: An online survey was designed with the aim of characterizing faculty understanding of the principles of CBME and common trainee assessment methods, as well as exploring barriers to the implementation of CBME in obstetrics and gynaecology residency programs across Canada. The survey was sent to faculty across Canada in English and French. RESULTS: A total of 284 responses were collected between September 2015 and December 2016. Although most faculty viewed CBME as a positive change, there were gaps in their knowledge about CBME and workplace-based assessment methods. Barriers to the implementation of CBME included lack of training in assessment of residents and feedback, financial implications, and time constraints. CONCLUSION: To facilitate the transition to CBME, institutions may need to consider establishing faculty training programs and implementing systemic change aimed at addressing faculty needs and barriers during this fundamental shift in the structure of residency training.

Applying Developmentally Supportive Principles to Diapering in the NICU: What We Know.

Developmental care measures are integrated in the NICU, but these measures are largely overlooked when it comes to standard care activities such as diapering. This general review of developmental care in the NICU discusses how caregivers can apply appropriate, individualized developmental care measures to diapering regimens. Numerous opportunities to expand developmental care measures into diapering care are identified; these opportunities can protect and promote sleep for hospitalized infants, enhance the diapering environment, minimize stress that infants may experience with diapering, improve infant skin health outcomes through use of evidence-based skin care practices, and foster family involvement during diapering care in the NICU. A developmental approach to diapering offers hospitalized infants regular opportunities to reach their neurodevelopmental potential.

Implementation of an Interprofessional Team Review of Adverse Events in Obstetrics Using a Standardized Computer Tool: A Mixed Methods Study.

OBJECTIVE: As part of a larger study, an interprofessional team piloted a computer tool called Standardized Clinical Outcome Review (SCOR) to review adverse obstetric events that occurred at a tertiary care hospital over a 12-month period. We sought to understand whether the SCOR tool offered a feasible, acceptable, and appropriate strategy for improving patient safety through improved review of incidents. METHODS: We designed a mixed methods implementation study. Following completion of the 12-month pilot period, team members completed a questionnaire and participated in a focus group. Quantitative data analysis was performed using descriptive statistics, and qualitative data were analyzed using grounded theory to generate themes. RESULTS: The SCOR tool was easy to implement with an interprofessional team. Despite technical challenges with the software, the tool was quicker and more efficient than traditional case review methods. The content was appropriate for an obstetric unit and provided objective identification of factors contributing to adverse events. Team members were positive about the use of the tool in their institution and in wider contexts and believed that it was a valuable tool for raising awareness and addressing patient safety at their unit. CONCLUSIONS: SCOR was an acceptable and appropriate tool for the interprofessional team review of adverse outcomes, and its use represents a significant advance in the quality assurance process for formal peer review of incidents.

Learning from Adverse Events in Obstetrics: Is a Standardized Computer Tool an Effective Strategy for Root Cause Analysis?

OBJECTIVE: Adverse events occur in up to 10% of obstetric cases, and up to one half of these could be prevented. Case reviews and root cause analysis using a structured tool may help health care providers to learn from adverse events and to identify trends and recurring systems issues. We sought to establish the reliability of a root cause analysis computer application called Standardized Clinical Outcome Review (SCOR). METHODS: We designed a mixed methods study to evaluate the effectiveness of the tool. We conducted qualitative content analysis of five charts reviewed by both the traditional obstetric quality assurance methods and the SCOR tool. We also determined inter-rater reliability by having four health care providers review the same five cases using the SCOR tool. RESULTS: The comparative qualitative review revealed that the traditional quality assurance case review process used inconsistent language and made serious, personalized recommendations for those involved in the case. In contrast, the SCOR review provided a consistent format for recommendations, a list of action points, and highlighted systems issues. The mean percentage agreement between the four reviewers for the five cases was 75%. The different health care providers completed data entry and assessment of the case in a similar way. Missing data from the chart and poor wording of questions were identified as issues affecting percentage agreement. CONCLUSION: The SCOR tool provides a standardized, objective, obstetric-specific tool for root cause analysis that may improve identification of risk factors and dissemination of action plans to prevent future events.

Objectif : Des événements indésirables se manifestent dans jusqu'à 10 % des cas obstétricaux et jusqu'à la moitié de ces événements sont évitables. Les analyses de cas et l'analyse des causes fondamentales au moyen d'un outil structuré pourraient aider les fournisseurs de soins à tirer des leçons des événements indésirables et à identifier les tendances et les problèmes systémiques récurrents. Nous avons cherché à établir la fiabilité d'un logiciel d'analyse des causes fondamentales connu sous le nom de Standardized Clinical Outcome Review (SCOR). Méthodes : Nous avons conçu une étude faisant appel à des méthodes mixtes pour évaluer l'efficacité de l'outil. Nous avons mené une analyse qualitative du contenu de cinq dossiers ayant été analysés tant au moyen des méthodes traditionnelles d'assurance de la qualité en obstétrique qu'au moyen de l'outil SCOR. Nous avons également déterminé la fidélité interévaluateurs en demandant à quatre fournisseurs de soins d'analyser les cinq mêmes dossiers au moyen de l'outil SCOR. Résultats : L'analyse qualitative comparative a révélé que le processus traditionnel d'assurance de la qualité dans le cadre de l'analyse des cas utilisait un langage hétérogène et formulait de sérieuses recommandations personnalisées à l'endroit des intervenants du dossier. En revanche, l'analyse au moyen de l'outil SCOR fournissait un format uniforme pour les recommandations et une liste de points de décision, en plus de faire ressortir les problèmes systémiques. Le taux moyen d'entente (en pourcentage) entre les quatre évaluateurs pour les cinq dossiers en question était de 75 %. Les autres fournisseurs de soins ont procédé à la saisie des données et à l'évaluation des dossiers de façon semblable. L'absence de certaines données dans les dossiers et la mauvaise formulation des questions ont été identifiées comme étant des problèmes affectant le taux d'entente. Conclusion : L'outil SCOR permet la tenue d'une analyse des causes fondamentales de façon standardisée, objective et centrée sur l'obstétrique, ce qui pourrait améliorer l'identification des facteurs de risque et la dissémination des plans d'action pour la prévention de futurs événements.

Birth technology and maternal roles in birth: knowledge and attitudes of canadian women approaching childbirth for the first time.

OBJECTIVE: To describe Canadian nulliparous women's attitudes to birth technology and their roles in childbirth. METHODS: A large convenience sample of low-risk women expecting their first birth was recruited by posters in laboratories, at the offices of obstetricians, family physicians, and midwives, at prenatal classes, and through web-based advertising and invited to complete a paper or web-based questionnaire. RESULTS: Of the 1318 women completing the questionnaire, 95% did so via the web-based method; 13.2% of respondents were in the first trimester, 39.8% were in the second trimester, and 47.0% in the third. Overall, 42.6% were under the care of an obstetrician, 29.3% a family physician, and 28.1% a registered midwife. The sample included mainly well-educated, middle-class women. The planned place of giving birth ranged from home to hospital, and from rural centres to large city hospitals. Eighteen percent planned to engage a doula. Women attending obstetricians reported attitudes more favourable to the use of birth technology and less supportive of women's roles in their own delivery, regardless of the trimester in which the survey was completed. Those women attending midwives reported attitudes less favourable to the use of technology at delivery and more supportive of women's roles. Family practice patients' opinions fell between the other two groups. For eight of the questions, "I don't know" (IDK) responses exceeded 15%. These IDK responses were most frequent for questions regarding risks and benefits of epidural analgesia, Caesarean section, and episiotomy. Women in the care of midwives consistently used IDK options less frequently than those cared for by physicians. CONCLUSIONS: Regardless of the type of care provider they attended, many women reported uncertainty about the benefits and risks of common procedures used at childbirth. When grouped by the type of care provider, in all trimesters, women held different views across a range of childbirth issues, suggesting that the three groups of providers were caring for different populations with different attitudes and expectations.

The attitudes of Canadian maternity care practitioners towards labour and birth: many differences but important similarities.

OBJECTIVE: Collaborative, interdisciplinary care models have the potential to improve maternity care. Differing attitudes of maternity care providers may impede this process. We sought to examine the attitudes of Canadian maternity care practitioners towards labour and birth. METHODS: We performed a cross-sectional web- and paper-based survey of 549 obstetricians, 897 family physicians (400 antepartum only, 497 intrapartum), 545 nurses, 400 midwives, and 192 doulas. RESULTS: Participants responded to 43 Likert-type attitudinal questions. Nine themes were identified: electronic fetal monitoring, epidural analgesia, episiotomy, doula roles, Caesarean section benefits, factors decreasing Caesarean section rates, maternal choice, fear of vaginal birth, and safety of birth mode and place. Obstetrician scores reflected positive attitudes towards use of technology, in contrast to midwives' and doulas' scores. Family physicians providing only antenatal care had attitudinal scores similar to obstetricians; family physicians practising intrapartum care and nurses had intermediate scores on technology. Obstetricians' scores indicated that they had the least positive attitudes towards home birth, women's roles in their own births, and doula care, and they were the most concerned about the consequences of vaginal birth. Midwives' and doulas' scores reflected opposing views on these issues. Although 71% of obstetricians supported regulated midwifery, 88.9% were against home birth. Substantial numbers of each group held attitudes similar to dominant attitudes from other disciplines. CONCLUSION: To develop effective team practice, efforts to reconcile differing attitudes towards labour and birth are needed. However, the overlap in attitudes between disciplines holds promise for a basis upon which to begin shared problem solving and collaboration.

The use of an ultrasound bladder scanning device in women undergoing urogynaecologic surgery.

OBJECTIVE: To compare the accuracy of using a bladder scanner to measure post-voiding residual urine volume with measurement by intermittent catheterization in a postoperative urogynaecology population. METHODS: Prior to implementation of the study, nurses were trained in the use of a bladder ultrasound scanner. Post-void residual urine volume in postoperative patients was assessed by a nurse with the scanner; a second nurse, blinded to the scanner result, then catheterized the patient's bladder. Each patient rated the pain experienced with bladder scanning and with catheterization. A prospective comparison of the volumes assessed by ultrasound and measured by catheterization used 127 pairs of data; each woman served as her own control. The correlation of urine volumes was determined, and the difference in pain score was calculated using the Student t test. RESULTS: The mean age of patients was 56.5 years (range 40-79). All four bladder quadrants were visualized in 34.4% of scans. The correlation coefficient for volumes measured by scanning and catheterization was 0.70 (P < 0.001; range -349 mL to +692 mL). Consistently, using the scanner resulted in underestimation of the urine volume. The sensitivity of the bladder scanner (0.58 for residual volumes > 200 mL) therefore makes it a poor tool for assessing postoperative urinary retention in women undergoing urogynaecologic surgery. Pain scores recorded with catheterization (2.9/10) were significantly less than those recorded with bladder scanning (4.2/10) (P < 0.001). CONCLUSIONS: Bladder scanning by staff nurses had limited value in assessing postoperative residual urine volumes. The accuracy of assessment might increase with greater experience with the procedure. The greater discomfort reported by patients with use of the scanner supports continued use of catheterization to assess residual urine volume.