Fetal Pillow at full dilatation Michael Beckmann Huda Safa

Background Deeply engaged fetal head RANZCOG guideline Fetal Pillow 1-2% of CS Associated with adverse maternal and neonatal outcomes RANZCOG guideline Fetal Pillow Mater Health Services first unit in Australia 2 fetal deaths subject to Coronial Investigation

Objective Report the initial Australian experience with use of the Fetal Pillow

Methods Retrospective cohort study Women who underwent CS at full dilatation Between May 2013- March 2015 Mater Mothers Hospitals, South Brisbane Data extracted from electronic maternity record Comparison Cases where the FP method was used Cases where the hand–push method was used Maternal and neonatal outcomes reported

Results 361 CS performed at full dilation FP-method 91 cases Hand-push method 69 cases Similar baseline characteristics Fetal Pillow Hand-push P-value Nullipara 82% 66% 0.15 Age 30y 31y 0.39 BMI 25 24 0.61 Gestation 40 0.54 Category 1 CS 49% 52% 0.95 Failed instrument 6% 4%

Results Women in whom the FP-method was used Shorter post-partum length-of stay Higher cord arterial pH Less EBL Other outcomes similar Fetal Pillow Hand-push P-value Apgar <7 @ 5 minutes 3% 6% 0.44 Intubated 0% 0.10 Nursery admission 15% 25% 0.14 Cord arterial pH 7.24 7.19 0.02* Mean EBL 273ml 403ml 0.03* Blood transfusion 0.71 Angle extension 20% 34% 0.09 Post-partum LOS 78h 98h 0.01*

Conclusions Initial findings Clinician feedback universally positive confirm others experience effective aid when deeply impacted fetal head larger numbers are needed Clinician feedback universally positive Risk minimisation