Does the American College of Obstetricians and Gynecologists (ACOG) recommend counting surgical sponges after vaginal delivery?

ACOG Recommends Sponge Counting After Vaginal Delivery

Yes, the American College of Obstetricians and Gynecologists (ACOG) recommends that surgical instruments, sponges, and sutures should be counted pre- and postoperatively after vaginal delivery, particularly for third- and fourth-degree laceration repairs. 1

Evidence for Sponge Counting Recommendations

• ACOG specifically states that "surgical instruments, sponges, and sutures should be counted pre- and postoperatively" as part of their perioperative considerations for obstetrical anal sphincter injuries (OASIS) repairs 1
• This recommendation appears in ACOG's guidelines for repair of episiotomy and obstetrical perineal lacerations, published in the American Journal of Obstetrics and Gynecology in 2024 1
• The recommendation is included in a checklist for OASIS repairs to ensure adherence to critical care processes and reduce errors 1

Rationale for Sponge Counting

• Retained surgical sponges (gossypiboma) following vaginal delivery are an uncommon but preventable occurrence 2
• Retained sponges can lead to significant complications including:
  • Malodorous discharge and infection 2
  • Need for additional procedures to remove the foreign body 3
  • Loss of patient confidence in providers and the medical system 2
  • Legal claims and medicolegal consequences 2, 4

Incidence and Impact of Retained Sponges

• Labor and Delivery accounts for approximately 32.7% of all retained surgical sponge events reported to The Joint Commission 3
• The vagina is the second most common anatomic location (23.9%) for retained sponges after the abdomen/pelvis (50.2%) 3
• One study found that implementing a sponge count protocol in delivery rooms was well accepted by healthcare teams and could be effectively incorporated into delivery room routines 2

Implementation of Sponge Counting Protocols

• Protocols that incorporate post-delivery vaginal sweep and sponge counts have been shown to reduce the occurrence of retained vaginal sponges 2
• Pre-implementation training is important for successful adoption of sponge counting protocols 2
• Some facilities have implemented radiofrequency technology to assist with sponge detection, showing a 93% reduction in retained surgical sponges compared to a 77% reduction with manual counting alone 5

Common Pitfalls to Avoid

• Relying solely on manual counting without a standardized protocol increases the risk of retained sponges 6
• Failure to perform accurate sponge counts is a significant risk factor for retained surgical items 4
• Emergency situations and unexpected changes in procedures increase the risk of retained sponges, making adherence to counting protocols even more critical in these scenarios 4

ACOG's recommendation for sponge counting is part of their broader guidance on ensuring patient safety during obstetrical procedures, particularly for more complex repairs such as third- and fourth-degree lacerations, but the principle applies to all vaginal deliveries to prevent potentially serious complications.