Dr Katie Cornthwaite (virtually) presents on improving fetal outcomes: the ABC approach to managing impacted fetal head at cesarean section. ABC = national programme, more than just impacted fetal head.
#OAA3dc2022
What is an impacted fetal head? Ball in flowerpot analogy (even has holes at bottom of the pot). First win was a consensus definition. Complications for both mother and baby. #OAA3dc2022
Impacted fetal head contributes to 10% most expensive claims (see @BogodDavid elsewhere). Complicates 1.5% births and 10% of emergency cesareans. Impacted fetal head complicates 32% of sections at full dilation, 56% in cesarean before full dilation. #OAA3dc2022
Prevention. Probably not #OBAnes directly, hopefully
Why is training required?
No consensus on safest approach, widespread variation, no national guidelines, impacted fetal head may need > 1 approach, may be avoidably harmful care. Training void.
#OAA3dc2022
They’ve come a long way since the survey.
Is it important to #OBAnes? Anesthesia & OR team required. Tocolysis. Trying to avoid the middle T-word but height may actually matter.
At least #OBAnes usually have a spiel for Talking (HT: Bill Cayman @BrighamOBAnes)
#OAA3dc2022
Impacted fetal head (IFH) algorithm 1.
Anticipate & Prepare.
Communication is key.
Pause - uterus relaxation takes a little time (reaching in equates to fundal rub?) & tocolysis has systemic effects.
#OAA3dc2022
IFH algorithm 2
Also Pause to PLAN & communicate it!
Would consultant/attending OB NOT be present? Doesn’t call for help imply that? If not, you may want to put that step a little earlier?
Anticipate & prepare for complications
#OAA3dc2022
Effective communication during cesarean section- are #OBAnes bad at it? Or only during emergencies?
Key communication messages: concur with all - however, I’ve been “advised” against some - “keep non-verbal comms minimal” “silence professional” “don’t scare patient”
#OAA3dc2022
Okay rewritten: to my mind, there appears to be a conflict between key messages of communication & language (as if done by different groups). Keeping it simple may conflict with correct communication, using exact, clear language is essential, earshot is unavoidable.
#OAA3dc2022
This is where some #OBAnes prefer partner out of the room, precisely because it may be traumatic. However, they’re inevitably present during emergencies. Adding a potentially conflicting voice to that of parturient is debatable, parturient should be focus? Thoughts?
#OAA3dc2022
Practical training is essential. Simulation even more so.
#OAA3dc2022
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