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Current state of knowledge of CTG among obstetric Anaesthetists - A Survey
Abstract Number: SAT-13
Abstract Type: Original Research
The UK National Institute of Clinical Excellence (NICE) recommends continuous 30 minutes CTG (cardiotocograph) monitoring in women receiving regional anaesthesia/analgesia1. An awareness of the principles & a systematic approach to CTG analysis is essential for the anaesthetists for communication & timely delivery of high risk fetus2. A 2014 Obstetric Anaesthetic Association(OAA) survey highlighted the knowledge deficiency &lack of standardized CTG module training for anaesthetsists, urging curriculum changes3. Anecdotal evidence suggested that this hadn’t occurred locally. We devised a survey to assess if any improvement in knowledge had occurred in our institution.
A questionnaire survey was conducted among 12 obstetric anaesthetic trainees & 8 consultant obstetric anaesthetists in a large obstetric unit. Questions examined their training, confidence in interpreting CTGs & assessed their interpretation of 5 CTGs within a limited timeframe. They were also questioned about anaesthetic implications of the obstetric situation.
45% had undergone training sessions to analyze CTG mainly in medical school with no subsequent updates.70% didn’t feel confident in basic CTG analysis.42 % of trainees & 40 % of consultants incorrectly interpreted CTG tracings. 62% correctly identified anaesthetic implications.75% of the respondents wanted training & identified that e learning (60%), courses (10%) & rounds (10%) would help.
Our survey shows continued CTG knowledge gaps despite the recommendations of the 2014 survey. Although Obstetricians have the primary responsibility for making clinical decisions, knowledge about CTG amongst anaesthetists promotes timely patient care, avoidance of intrapartum harm & reduces litigation3. It is worrying that 42% trainees, who are front line providers, didn’t interpret the CTG tracing, hence didn’t correctly identify the anaesthetic implications. Previous confidential enquiries have shown lack of knowledge, poor training of staff contributing to maternal morbidity & mortality. Our results highlight an urgent need to review the curriculum to improve training & mandate regular refresher training for senior anaesthetists.Our labour ward induction programme has changed, ensuring all new trainees have access to an e-learning module & have focused time with labour ward practitioners to help with experiential learning. We believe that this needs to be replicated in other institutes to improve maternal care .
2. Royal College of Anaesthetists. Curriculum for CCT in Anaesthetics, OB_BK_04: Recalls/describes how to assess fetal well-being in utero, edition 2, version 1.7. pg. B-47
3. OAA survey -153 Survey of CTG interpretation and training amongst obstetric Anaesthetists