1. Fetal Pillow Experience at SWBH NHS Trust Birmingham Mr.R.Ganapathy
Consultant Maternal Fetal Medicine
Epsom and St. Helier University Hospitals NHS Trust.

2. 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 /year.

3. 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.

4. 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%

5. 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

6. Results: Caesarean
Indications

7. Results – Patient Type

8. 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

9. 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%

10. 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£

11. 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

12. 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.

13. Thank you Conflict of interest: None Mr.R.Ganapathy
Consultant Maternal Fetal Medicine
Epsom and St. Helier University Hospitals NHS Trust.