Transcript Foetal Pillow Audit

Fetal Pillow
Experience at SWBH NHS Trust Birmingham
Mr.R.Ganapathy
Consultant Maternal Fetal Medicine
Epsom and St. Helier University Hospitals NHS Trust.
SWBH NHS Trust
 5800 deliveries a year
 Caesarean section rate between 24 to 26%
 Three tier system of trainees/resident doctors.
 Obstetric Consultants 8.
 On site consultant presence 12 hours/day.
 Second stage caesareans – around 80-100/year.
Complications in second
stage C.S
 Difficult head delivery.
 Increased HDU admission.
 Uterine angle extension.
 Neonatal morbidity.
 Vaginal / cervical tear.
 Need for repeat caesarean
 Bladder damage.
 PPH.
 High maternal morbidity
section.
 Increased operative time.
 Medico legal issues.
McKelvey (2010): UK Study
 Total Mat. Comps
57%
 Uterine extensions 11.0%
 Cervical/vaginal tears 4.4%
 PPH >1000 mls
40%
 Transfusion
19.8%
 Admission to ICU
3.3%
Fetal pillow
 Takes around 10 minutes to be trained in it- for
any doctor.
 Training of all labour ward staff and theatre
staff over a 4 week period
 Used a training model for the pillow along with
the video(provided by the company).
 Training on going to ensure all new staff/locum
staff trained in use- On a 3 monthly basis
 N=57
Results: Caesarean
13%
Failure to Progress
Malposition/deep
transverse arrest
12%
44%
6%
Fetal
distress/pathological CTG
Deflexed OP
Failed Ventouse
19%
Failed Forceps
6%
Indications
Results – Patient Type
13%
37%
18.5-25
25-30
>30
50%
BMI
Complications/
morbidity
Prior rate of
complications
 Uterine tear
extension rate of
rate prior to use of
fetal pillow was
After use of fetal pillow
10%
 5.2%
5%
 0%
20
 5.2%
 vaginal or cervical
tear (previously
 Post partum
haemorrhage(PPH
) >1500mls
HDU
care/Transfusions
Previous rate of complications
 High dependency
unit for a 24 hour
period after
massive obstetric
haemorrhage
 Blood transfusion
After use of fetal pillow
10%
 3.5%
15%
 5.2%
Hospital Stay
Average duration of stay
 average of 5 to 7 days with complications.
After use of fetal pillow
 2.7 days
This is associated with a significant cost reduction.
Per day stay –hospital hotel charges around £450
HDU care higher at 750 to 1000£
Neonatal outcomes
 Given the uncommon occurrence of HIE we cannot
speak about the reduction in HIE with fetal pillow
although this should be a natural consequence of ease
of delivery. The numbers required to prove this can only
be achieved by combining data from many units.
 We had 2 cases of neonatal admissions, both were for
observation over a 2 day period for suspected
chorioamnionitis in the mother.
 Infection in two cases was limited to superficial wound
infection and one was associated with a hospital stay
for one day
Delivery of Head
 3 cases reported as difficult delivery- Of these in one
case- less saline used than recommended only 50 mls.
2 others operator unfamiliar with technique.
 Rest of the cases all reported as extremely easy
delivery of the head.
Thank you
Conflict of interest: None
Mr.R.Ganapathy
Consultant Maternal Fetal Medicine
Epsom and St. Helier University Hospitals NHS Trust.