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SPOILT audit - in utero resuscitation for category 1 Caesarean sections.
Abstract Number: S 20
Abstract Type: Original Research
Introduction:Intrauterine resuscitation (IUR) of the fetus is aimed at improving fetal condition during labour and before an emergency delivery. Our departmental guidelines suggest that IUR should be attempted before all category 1 caesarean sections (CS). Our unit uses an acronym- SPOILT -to describe IUR. It stands for: Syntocinon infusion discontinued, Pressure (hypotension) corrected, Oxygen applied, Intravenous fluid infusion (IVI) started, mother in Left lateral position, Tocolysis. We aim to improve oxygen delivery to the fetus so that 1)it's delivered in best possible condition,2)we gain time to deliver the safest anaesthetic.
Methods:We audited our pracice to see if SPOILT principles were applied in category 1 CS. We designed a questionnaire, anaesthetists completed a form for each category 1 CS, and collected data for 2 months (06-07/2011). We acquired a total of 17 responses; data were collected and correlated.
Results:In all cases syntocinon was discontinued appropriately. 65% of the patients arrived in left lateral position. 35% of the women had oxygen applied. IVI was started in 65% of patients. One patient had tocolysis initiated, 76% did not have it in place. Most of the cases (82%) were done by ST3-4 grade anaesthetists, 12% by consultants. There were 35% of general anaesthetics (GA), 35% of labour epidural top-ups, 18% spinals. 2 cases were converted to GA. Most of the newborns had Apgar scores of 9-10 in minutes 1 (9 newborns) and 5 (11 newborns).
Discussion: We could improve our compliance with SPOILT principles for category 1 CS. Our numbers are small which we attribute to the stressful environment related to emergency CS. We would have expected more than 65% of patients to arrive in the theatre with left lateral tilt in place. The little use of oxygen on transfer is likely due to the fact that portable oxygen is not routinely available in our labour rooms. There is a pipeline supply to each room and a large portable cylinder on wheels for the LS. However, often it is quicker to move the patient to theatre than wait for the cylinder to arrive. IVI was started in 65% only, possibly some cases had difficult IV access and cannulation was left to anaesthetist in theatre. There was a rather large number of GA (35%). In view of recent CMACE report we should emphasize the importance of early labour epidural top-up for conversion to anaesthesia, which, where appropriate, should start in the LS and might reduce the number of unnecessary GA. More education is needed and all specialities should feel responsible for initiating SPOILT manouvers. A size C or D oxygen cylinder could be kept in each room. Emphasis on IV access in the room is important and would allow early fluid resuscitation. A reaudit should be performed.
1.Centre for Maternal and Child Enquiries (CMACE).Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom.