H. Gee
MD, FRCOG
Consultant Obstetrician
Right patient has to be taken at the
right time by the right people to the
right place using the right form of
transport and receiving the right
type of care throughout.
N=153
*
N=153
ACCEPT
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Assessment
Control
Communication
Evaluation
Preparation & Packaging
Transportation
Coping with Caesarean
Section Risk
Delivery where CS available?
• Obstetric history
– Previous CS
– Previous SB
– Parity
• P 0 or P5
– Previous PPH
– Previous eclampsia
– Previous sepsis
Delivery where CS available?
• Maternal health problems
– small pelvis
• Height < 150
– Scoliosis/Spinal Abnormalities
– Pelvic mass
• fibroids
– High blood pressure
– HIV
– Rhesus -ve
Delivery where CS available?
• Problems this pregnancy baby
– Multiple pregnancy
– Mal-Presentation
– Bleeding in pregnancy
– Large baby?
– Small baby?
– Risk factors for LBW
Anticipating Need for
Neonatal Resuscitation
Who at risk of low birth weight?
• Prematurity
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Accurate Dating(Early Ultrasound)
History
APH
SROM
Multiple
• Small baby
– Clinically
– Utero-Placental Insufficiency
• Pre-eclampsia/Eclampsia
• Multiple
Action
What can you do as a clinical
leader?
• Case reviews/critical incident review.
• Clinical audit conducted.
• Clinical audit recommendations
implemented.
• Re-audit planned/carried out.
Clinical Audit
• Maternal deaths
• 41% delay in arrival
• 34% delay in transfer
• 26% deaths delay in correct diagnosis
• Referrals
• Communication
• Complete Information
• Correct Information
• Planned delivery in hospital
Audit of Transport,
Equipment & Drugs
• Delay in getting to health centre.
• Delay between health centre and hospital.
• Drug availability & use at health centre.
– e.g. Magnesium Sulphate
• Availability of appropriate equipment.
Communication/education
• Warning of transfer so that receiver can be
prepared.
• Complete clinical notes on transfer.
• Midwives in health centres up to date on:
– Guidelines of care
– Starting treatment
Consider Implementing:
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Education & training of team.
Guidance on Place of Delivery.
Stock checking protocol & restocking schedule.
Adopting clear methods of communication