Simon Ash Profile picture
Nov 9 11 tweets 13 min read
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 ImageImageImage
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 ImageImageImageImage
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 ImageImageImage
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 ImageImageImageImage
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 ImageImageImage
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 ImageImageImageImage
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 ImageImageImage
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 ImageImageImageImage
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 ImageImageImageImage
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 ImageImageImage
Practical training is essential. Simulation even more so.
#OAA3dc2022 ImageImageImageImage

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More from @OBsleepmerchant

Nov 11
@euklaas from @asznl presents on PDPH: new perspectives at #OAA3dc2022. (As promised by teaser) August Bier = father of PDPH, a surgeon started it not #OBAnes 😉 ImageImageImageImage
Current perspective on PDPH. ICHD-3 definition, tied to CSF pressure & volume as is pathophysiology. #OAA3dc2022 ImageImageImage
New anatomical perspectives challenge the classic CSF hypothesis. Choroid plexus not main site of production, CSF doesn’t circulate unidirectionally.

Bulat-Kiarica-Orešković hypothesis: osmotic & hydrostatic forces are main determinants of CSF movement, pulsates

#OAA3dc2022 ImageImageImage
Read 14 tweets
Nov 10
Everyone needs to be on #Medtwitter @StephenLap! Watching @obstetriciasati talk about Obstetric hemorrhage I notice a trend observed at #OAA3dc2022 continuing: manual external aortic occlusion (a REBOA without surgeons or balloon catheter) Image
Dr Ove Karlsson and EXAC group have an article in press:

sciencedirect.com/science/articl…

#OAA3dc2022
Find out more at:

exac.no/about

#OAA3dc2022 ImageImage
Read 4 tweets
Nov 10
@Airwayman1 presents on #HumanFactors in #OBAnes. MedTRiM: medical trauma & resilience management - reminding us of the Declaration of Geneva #OAA3dc2022 ImageImageImageImage
The Boabab lesson (Zambia) applicable to #OBAnes #OAA3dc2022 Image
The plan for the talk. Your patient - straight after new bag sats drop…
NOT Swiss cheese (@girardDev), Emmental(?) model #OAA3dc2022 ImageImageImageImage
Read 14 tweets
Nov 10
@ArviPalanisamy presents his philosophy on the Future of #OBAnes Research in this final session of #OAA3DC2022: practical, aspirational, inspirational (skipping the queue to catch a train, @noolslucas & @OAAinfo) very accommodating in view of train/tube strikes affecting London) ImageImageImageImage
#OBAnes research has plateaued, advancing in increments. A change in thinking is required. Several low hanging fruit, #MindTheGap between #OBAnes research and practice - implementation science something for future? #OAA3dc2022 ImageImageImageImage
One subject ripe for implementation science study is awareness. DREAMY study factors associated are known, awareness common (perhaps we’re losing a skill?) & linked to PTSD. #BridgeTheGap #OAA3DC2022 ImageImageImageImage
Read 9 tweets
Nov 10
@girardDev presents on managing the obese parturient at #OAA3dc2022. He sets the bar high for the future of presentations at #SOAPAM2023, #OAA23, #ASM23SYD: a QR code that links to all his references as well as a pdf of his slide deck - perfect for #OBAnes #SoMe & #FOAMed. ImageImageImageImage
The value of PERI-oxygenation in obesity is not to be ignored. All patients will go blue, perioxygenated ones take 52 seconds longer (how long it feels depends on the sats?). We all remember the troop pillow, but do we remember the stool? Ergonomics of intubation #OAA3dc2022 ImageImageImage
@mbrrace meeting 10 November. Hope to see some live tweets of key messages @SusannaStanford. “We are ALL part of the solution” #OBAnes and obesity is definitely part of the puzzle, preventing it part of the solution. #OAA3dc2022 Image
Read 11 tweets

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