Search results

Aims to assess the benefits of using a mnemonic to structure the care given during episodes of shoulder dystocia, an obstetric emergency that has important sequelae for the mother and infant. A retrospective case‐notes‐based study was carried out to describe practice prior to the introduction of the mnemonic. A prospective study was undertaken to evaluate the use of a mnemonic in practice, and whether this had an effect on foetal morbidity. Prior to the introduction of the mnemonic and structured documentation, care was delivered in an unstructured and in a non‐evidence‐based manner in 35 per cent of patients; documentation was incomplete in 68 per cent of cases. There was a 5 per cent incidence of injury to the infant. Following the introduction of a mnemonic, the use of evidence‐based manoeuvres increased to 100 per cent, and care was delivered in a structured manner and there were no recorded injuries to infants. The management of shoulder dystocia has been made safer and more controlled by using a mnemonic to describe an evidence‐based pathway. It has facilitated a multi‐disciplinary team‐based approach to the management of this obstetric emergency.

Many organisations, including the Royal College of Obstetricians and Gynaecologists, have recommended increasing the number of hours of consultant obstetric presence in UK National Health Service maternity units to improve patient care. St Mary’s Hospital, Manchester implemented 24-7 consultant presence in September 2014. The paper aims to discuss these issues.

To assess the impact of 24-7 consultant presence upon women and babies, a retrospective review of all serious clinical intrapartum incidents occurring between September 2011 and September 2017 was carried out by two independent reviewers; disagreements in classification were reviewed by a senior Obstetrician. The impact of consultant presence was classified in a structure agreed a priori.

A total of 72 incidents were reviewed. Consultants were directly involved in the care of 75.6 per cent of cases before 24-7 consultant presence compared to 96.8 per cent afterwards. Negative impact due to a lack of consultant presence fell from 22 per cent of the incidents before 24-7 consultant presence to 9.7 per cent after implementation. In contrast, positive impact of consultant presence increased from 14.6 to 32.3 per cent following the introduction of 24-7 consultant presence.

Introduction of 24-7 consultant presence reduced the negative impact caused by a lack of, or delay in, consultant presence as identified by serious untoward incident (SUI) reviews. Consultant presence was more likely to have a positive influence on care delivery.

This is the first assessment of the impact of 24-7 consultant presence on the SUIs in obstetrics.

Each year approximately 3,200 women have a stillbirth in the UK. Although national evidence-based guidance has existed since 2010, case reviews continue to identify suboptimal clinical care and communication with parents. Inconsistencies in management include induction and management of labour and the frequency of investigation after stillbirth. The paper aims to discuss these issues.

An audit of stillbirths was performed in 2014 in 13 maternity units in the North West of England, this confirmed variation in practice described nationally. An integrated care pathway (ICP) was developed from national guidelines to enable optimal care for the management of stillbirth, reduce variation, standardise investigations and coordinate patient-focussed care. This was launched in 2015 and updated in 2016 to resolve the issues that were apparent after implementation.

Each participating unit had commenced using the ICP by May 2015. Following implementation there were changes in care, most notably from diverse methods for the induction of labour to guideline-directed induction of labour. There were trends towards better care in terms of information given, choices offered, more appropriate analgesia in labour and improved post-delivery investigation for cause. Staff feedback about the ICP was positive.

The use of this ICP improved care for women who had a stillbirth and their families. Issues with implementing a changed care pathway meant that further iterations were required, ongoing improvement is expected following the refinement of the ICP.

ICPs have been used for various clinical conditions. However, this is the first example of their use in women who had a stillbirth.