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 Trust5800 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.

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%

McKelvey (2010): UK Study

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

44%

6%

19%

6%

13%

13%

Failure to ProgressMalposition/deep transverse arrestFetal distress/patho-logical CTGDeflexed OPFailed VentouseFailed Forceps

Indications

Results – Patient Type

38%

50%

13%

BMI

18.5-2525-30>30

Complications/morbidity

Prior rate of complications

Uterine tear extension rate of rate prior to use of fetal pillow was

vaginal or cervical tear (previously

Post partum haemorrhage(PPH) >1500mls

After use of fetal pillow

5.2%

0%

5.2%

10%

5%

20

HDU care/Transfusion

sPrevious rate of complications

High dependency unit for a 24 hour period after massive obstetric haemorrhage

Blood transfusion

 

After use of fetal pillow

3.5%

5.2%

10%

15%

Hospital StayAverage duration of

stay

average of 5 to 7 days -with complications.

After use of fetal pillow

2.7 days

This is associated with a significant cost reduction. Per day stay –hospital hotel charges around £450HDU care higher at 750 to 1000£

Neonatal outcomesGiven 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.GanapathyConsultant Maternal Fetal MedicineEpsom and St. Helier University Hospitals NHS Trust.