Guideline 19: Prevention of Retained Sponges and Needles Following Vaginal Delivery

Retained foreign objects after surgeries or procedures are considered serious reportable events, one of the 28 events identified in the Commonwealth of Massachusetts’ uniform non-payment policy.¹ Retained foreign objects following vaginal delivery and obstetrical surgery procedures are events that can usually be prevented by implementing the following steps:

• Two qualified personnel, including the primary nurse, will perform sponge and needle counts before and after each delivery. The counts should be documented in the medical record. If a pre-delivery sponge count is not possible, as with a precipitous delivery, then sponges shall not be utilized until after the delivery, when a count can be systematically performed prior to their use.
• All sponges used in deliveries should be radio-opaque.
• If there is a discrepancy in the sponge count at the completion of the delivery, then manual search of the vagina should be performed and findings documented by the delivering obstetrical provider. If the discrepancy persists, then the further search of the delivery area should be performed and findings documented in the medical record. A diagnostic X-ray of the patient may be considered to ensure missing sponges are not retained in the vagina.
• If there is a discrepancy in the needle count and careful inspection of the vagina and search of the delivery area do not locate the needle, then diagnostic X-ray is expected to ensure that the missing needle is not retained in the patient.
• The nurse should record the final status of the sponge and needle counts on the Labor and Delivery patient flow record and the obstetrical provider should similarly document in the delivery note.
• Purposeful placement and retention of vaginal sponges or packing in the vagina, as in the setting of post partum hemorrhage, necessitates a reliable method of tracking and communicating such with members of the obstetrical care team.

1. HealthyMass Serious Reportable Events Task Force, POLICY GUIDELINES. Available at: http://www.mass.gov/eohhs/docs/eohhs/healthymass/sre-guidelines.pdf. Accessed June 20, 2013.