1. Croydon Health Services Maternity Care
Bini Ajay
Consultant Obs & Gynae
Midwifery Managers
Karen Rooke & Becky Board
23/03/17

2. Teamwork
Video

3. Croydon Health Services Maternity Data 2016
Total Deliveries 3877 SVD Rate 59% Birth Centre rate 12.8% Ventouse Rate 9.5% Homebirth rate 2.4% Forceps Rate 4.6% C/S Rate 27.0 Massive PPH >2Litres 29 3rd & 4th Degree Tears %
23/02/17

4. Maternity Headlines CHS
Maternity ambition to reduce the rate of stillbirths, neonatal and maternal deaths in England by 50% by 2030
Reducing smoking in pregnancy
Risk assessment and surveillance for fetal growth restriction
Raising awareness of reduced fetal movement
Effective fetal monitoring during labour
National maternity review- Continuity of carer; multiprofessional working; personal maternity budgets
Market repatriation
Successful bids
-£58K HEE maternity safety training fund
-£10K DoH innovation reducing admission to NNU
12/2/201712/2/2017

5. GAP

6. Clinic days Consultant Special interest Specialist Midwife Mon AM
Mr Emmanuel Ofuasia
Fertility, Fibroids
Infectious Diseases Midwife
Mon PM (alt weeks)
Miss Heather Allen-Coward
Fetal medicine- previous Pre-eclampsia, IUD,IUGR, Breech
Specialist Midwife Vaginal Birth after Caesarean Section VBAC
Mon PM (alt week)
Miss Maha Alkatib
Pregnancy with Mental Health issues, LLETZ/cervical treatment
Specialist Midwife Mental Health
Jenny Heriot Consultant Anaesthetist
Anaesthetic Complications Clinic
Tues AM
Mr David Rose
Vaginal Birth after Caesarean Section VBAC
Specialist Midwife VBAC
Teenage Pregnancy Midwife
Tues PM
Mr Naguib
Complex pregnancies High BMI
Perineal Specialist Midwife
Miss Hamid
Wed AM
Mr Mike Booker
IVF pregnancies/ fertility treatments
 Lead Midwife Multiple Pregnancy
Postnatal follow up for complex cases
Wed PM
Miss Rosol Hamid
Multiple pregnancies, High risk obstetrics
Thurs AM
Miss Bini Ajay
Dr Savin Endocrinologist
Pregnancy with diabetes and Thyroid disorders
High BMI>50
Specialist Midwife Diabetes
Thurs PM
Mr Ahmed Kamel
Infectious Diseases: HIV, Hepatitis, Sickle cell disease
Fri Am Purley
Mr Greg Ward
High risk pregnancies
Fri Am
Maple Clinic
Alcohol and drug dependency
Safeguarding Midwife

7. Working together to improve the pathway What GP’s can do?
Early electronic referral to enable booking by 9+6 weeks
Antihypertensive- change to Labetalol 200mg BD
Start Aspirin 75mg from 12 weeks -Previous IUGR, Hypertensive, Diabetic
Diabetic- HbA1c <60
BMI> 60 referral to tertiary center for pregnancy care
Hypothyroid- increase thyroxine
Cardiac problems- refer for urgent ECHO
Suspected abnormal fetal growth – symphysis /fundal height (in cms) measurement which varies either + or – 3cms from 24 weeks
refer to day assessment unit (DAU) ext. 3469
Obstetric Cholestasis suspected Bile acid, LFTs refer to DAU
Reduced fetal movement refer to DAU

8. Day Assessment Unit ( )
Raised BP: Management of suspected or confirmed PET
Decreased fetal movements
Small for gestational age / IUGR on scan: Large for gestational age on scan
Fetal heart rate irregularities
Abdominal pain
Post dates >41+5 weeks without a plan for induction of labour
Preterm prelabour ruptured membranes (PPROM) (<37 weeks)
Possible preterm labour (< 37 weeks) but no regular contractions
Abnormal LFTS and history suggestive of obstetric cholestasis
Suspected breech or doubt about fetal presentation beyond 36 weeks gestation
Trauma / assault – following maternal wellbeing assessment in emergency department
Monitoring of a pregnancy with a poor obstetric history (after discussion with the obstetric consultant)
Outpatient antenatal steroids

9. Maternity Triage CRITERIA FOR TRIAGE
Self referral/referrals accepted after telephone triage with obstetrician
Suspected labour between weeks pregnant
Pre labour spontaneous rupture of membranes
Possible preterm labour (< 37 weeks) with irregular contractions
Minor vaginal bleeding
Postnatal

10. Care in labour Choice of place of birth: Home birth Birth Centre
Consultant led care on Labour Ward
98 hours consultant presence in LW
24/7 anaesthetic cover
Consultant midwife-normalising Birth

11. Post delivery Day 1CMW visit Day 5 MSW visit NBBS Day 10 CMW discharge
Consultant led postnatal clinic high risk & counseling
Community Infant feeding clinics
Amlodipine introduction postnatally
Epidural- post dural headache – contact anesthetists
12/2/201712/2/2017

12. Research and Development
Research programme- Multicenter RCT ANODE,PHOENIX,STOPPIT2
Stem cell collection
12/2/201712/2/2017

13. Choose Croydon Maternity Services
12/2/201712/2/2017