1. Management of Parturients Who Decline Blood Transfusion OAA National Survey 122 A Jennings & C Brennan

2. Introduction Increased morbidity and mortality Require particular management

4. Methods OAA National Survey 122 Sent to lead obstetric anaesthetists

5. Survey Objective To establish current UK anaesthetic practice when managing JWs –Consent –Pre-optimisation –Anaesthetic technique –Facilities available –Seniority of staff involved

6. Response rate 70%

7. Antenatal Care Majority Have a policy – 85% Use specific no blood consent form – 85% See patients in clinic – 70% Minority Routinely administer prophylactic haematinics – 36% Erythropoietin (if anaemic) – 20%

8. In a High Risk LSCS…

9. Senior Input What is deemed mandatory in all cases? Consultant anaesthetist-led theatre care: 30% Consultant obstetrician-led surgery: 24% Consultant haematologist notified: 23%

10. Facilities– Cell Salvage Continuous connectivity mode Discuss antenatally: 53% Provide a 24hr service: 21% No cell salvage at all: 25%

11. Facilities– Interventional Radiology 24-hour access to interventional radiology service:27%

12. Postnatal Syntocinon Infusion Routine use in: Caesarean Section: 48% All forms of delivery: 22%

13. Centralisation of Services? 42% felt JWs should be managed in specified regional centres where appropriate facilities, staffing and expertise are guaranteed 24-7.

14. Conclusion Substantial variation in management demonstrated Many units are not equipped to meet the JW care plan Substantial support for centralisation of services for JWs. This is worthy of further discussion.