Manufacturing fault
All devices were disinfected and inspected following their use as per
protocol. During this inspection, four devices were found to have an
ineffective bulb pump (Figure 1) which resulted in inadequate cuff
inflation (Table 1). Operators comments during the attempted births
reflected this, as the device did not act in the expected manner for
them.
D4: ‘Yes, there was no grip… It just came out deflated, so
it didn’t feel right.’
A rapid retrospective review of all used and stored devices was then
undertaken to ensure that no other unsuccessful attempts could be
attributed to this fault.