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. Uterine angle extension. Vaginal / cervical tear. Bladder damage. PPH. High maternal morbidity Increased HDU admission. Neonatal morbidity. Need for repeat caesarean 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 Indications

Results – Patient Type

Complications/morbidity After use of fetal pillow Prior rate of complications 5.2% 0% Uterine tear extension rate of rate prior to use of fetal pillow was vaginal or cervical tear (previously Post partum haemorrhage(PPH ) >1500mls 10% 5% 20

HDU care/Transfusions Previous rate of complications After use of fetal pillow 3.5% 5.2% High dependency unit for a 24 hour period after massive obstetric haemorrhage Blood transfusion   10% 15%

Hospital Stay After use of fetal pillow Average duration of stay average of 5 to 7 days - with complications. 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.