Feasibility Study to Evaluate the Role of a Novel Device in Childbirth (PRINCE)

Feasibility Study to Evaluate the Role of a Novel Device in the Prevention of Retained Items In Childbirth Environment- Clinical Usability Pilot Study

Accidentally retained surgical items or swabs are well-recognised errors that result in adverse consequences for patients. This error is one of the commonest "Never Events" - patient safety incidents that are considered preventable. Although uncommon, these incidents can have devastating consequences. Retained surgical items have 70% re-interventions, reaching 80% morbidity and 35% mortality.

Swabs or sponges are like small towels that soak up blood and body fluids so that the surgeon can visualise the operating area effectively. Swabs are used in all areas of surgery which include operations on the tummy, chest, limbs. They are also used in the vagina during childbirth, to assess for tears and to minimise blood oozing from the vagina.

The common risk factors for this error are out of hours surgical or childbirth procedures, multiple handovers in the care of the patient, raised BMI (Body Mass Index) and unplanned change to the operative intervention.

As the name suggests, a 'never event' should never happen in the first place. Never. Unfortunately, this is not the case. Incidents involving surgical swabs being left behind, particularly during a caesarean section or a perineal repair following a vaginal birth, are still happening despite over 100 years of institutional awareness of the problem and tentative solutions being implemented in clinical practice.

never-event incidents involving retained surgical swabs are a widespread problem affecting healthcare systems worldwide. It is therefore reasonable to ask the question: why are surgical swabs being left behind and what can be done to prevent this from happening?

Study Overview

• Status: Not yet recruiting
• Conditions: Childbirth; Surgical Item, Retained
• Intervention / Treatment: Device: iCount system assembled with swabs

• Study Type: Observational
• Enrollment (Estimated): 70

Contacts and Locations

• Study Contact: Name: Aditi Desai; Phone Number: 01902695166; Email: aditidesai@nhs.net

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Pregnant women during labour

Description

Inclusion Criteria:

• Midwifery lead and consultant lead patient older than 18 years.
• Consented to participation after an informed choice.

Exclusion Criteria:

• Under 18 years of age

Antenatal (before labour):

• Patients who have a high risk of expected/unexpected maternal, fetal or neonatal deterioration such that during birth, the focus of attention would be towards safe patient care and observation required for using the swab-counter device system would not be possible such as :
• Patients who are seriously unwell and require high dependency care.
• Maternal cardiac conditions
• Severe pre-eclampsia
• Fetal anomalies where neonatal deterioration is expected (These will be relatively rare conditions where the doctor/midwife would decide to not recruit the patient)

Intrapartum and postpartum factors:

• Patient having an emergency Caesarean section instead of a vaginal birth due to maternal or fetal indication.
• Eclampsia (seizure/fitting in labour or after delivery)
• Maternal cardiac conditions requiring high dependency care
• Severe sepsis requiring high dependency care
• Fetal anomalies where neonatal deterioration is expected

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
iCount Device; A novel external device which can count the swabs and surgical tampons used during childbirth in an objective and validated manner.	Device: iCount system assembled with swabs; Designed as single use. Intended purpose - To be used to count swabs and tampons after childbirth in an objective manner. This is intended to be used in women during and after childbirth.
User Feedback Survey; Feedback will be taken from 20 users including midwives/ doctors. Users will be emailed an online survey or given the same survey as a printout to complete. All 20 users will also then also be approached to have a semi-structured interview. 10 of the users who first express interest will be interviewed.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Rate of device count accuracy (conspicuity of spotting a missing swab) measured via staff questionnaire feedback	12 months
User experience about general look and feel and user satisfaction (overall perception) measured via staff questionnaire feedback	12 months
User perception about the confidence about the accuracy of the count with use of the device and thoughts about intention to use, if available (functionality) measured via staff questionnaire feedback	12 months
User perception about the ease of learning of how to use the device measured via staff questionnaire feedback	12 months
User perception of how device works within current system measured via staff questionnaire feedback	12 months

Collaborators and Investigators

• Sponsor: The Royal Wolverhampton Hospitals NHS Trust
• Investigators: Principal Investigator: Aditi Desai, The Royal Wolverhampton NHS Trust

Study record dates

Study Major Dates

• Study Start (Estimated): September 1, 2026
• Primary Completion (Estimated): September 1, 2027
• Study Completion (Estimated): September 1, 2027

Study Registration Dates

• First Submitted: May 3, 2022
• First Submitted That Met QC Criteria: May 12, 2022
• First Posted (Actual): May 13, 2022

Study Record Updates

• Last Update Posted (Actual): April 9, 2026
• Last Update Submitted That Met QC Criteria: April 8, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Wounds and Injuries; Foreign Bodies
• Other Study ID Numbers: 2021SUR119

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No