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FLOSS before you fly: a novel intrauterine resuscitation care bundle
Abstract Number: F-29
Abstract Type: Original Research
Intrauterine fetal resuscitation (IUFR) improves fetal oxygen delivery during acute compromise(1). We show that although medical staff on our unit have good knowledge of IUFR measures, they are rarely implemented in the preoperative period after a decision to deliver. We designed a novel IUFR care bundle, with the mnemonic ‘FLOSS’ (Fluid, Left lateral position, Oxygen, Stop syntocinon, Stop contractions). After educational sessions, we demonstrated improved uptake of these measures.
Medical staff members on our delivery unit, including obstetricians and anaesthetists of all grades, and midwives, were approached by an author and questioned as to what actions they would take if they suspected acute fetal distress (pre-intervention questionnaire). Subsequently we audited emergency Caesarean sections performed for fetal distress (pre-intervention audit). The implementation of IUFR measures was analysed by the anaesthetist at the time of entering the OR. After analysis of results, a brief teaching session on IUFR measures was delivered during staff handover periods, and the OR audit repeated (post-intervention audit).
Pre-intervention questionnaire responses were obtained from 21 midwives, 16 obstetricians and 19 anaesthetists and were grouped into five categories: administration of intravenous fluid (midwives 81%; obstetricians 81%; anaesthetists 84%), adopting the left lateral position (midwives 100%; obstetricians 94%; anaesthetists 95%), administration of oxygen (midwives 5%; obstetricians 31%; anaesthetists 84%), stopping syntocinon (midwives 62%; obstetricians 50%; anaesthetists 58%), and starting tocolytics (midwives 5%; obstetricians 13%; anaesthetists 16%).
Results from the pre-intervention audit showed that in parturients with suspected fetal distress (n=26): 58% had received intravenous fluid, 27% were in the left lateral position, oxygen was given to 8%, syntocinon was stopped in 46%, and tocolytics were given in 4%.
After the delivery of teaching sessions to midwives at daily handover sessions, and the deployment of the ‘FLOSS’ care bundle, the post-intervention audit results (n=10) were as follows: IV fluid administered in 100%, left lateral positioning employed in 100%, and syntocinon stopped in 100%. No patient was administered oxygen nor tocolytic drugs.
We demonstrated that in spite of good knowledge of IUFR measures by medical staff on labour ward, they were infrequently implemented. By developing a simple acronym for an IUFR care bundle, we improved uptake of three of the key interventions. Further work may be required to improve uptake of oxygen and tocolysis, though the former has caused controversy(2).
1. Lindsay MK. Intrauterine resuscitation of the compromised fetus.Clin Perinatol 1999;26(3):569-84
2. Hamel MS, Anderson BL, Rouse DJ. Oxygen for intrauterine resuscitation: Of
unproved benefit and potentially harmful,Am J Obstet Gynecol(2014),doi:10.1016/j.ajog.2014.01.004