Background A global pandemic has resulted in the international suspension of face-to-face teaching in educational institutions. Medical students undertaking their clinical attachment in Obstetrics and Gynaecology would learn through experiential learning in normal circumstances. This unprecedented international emergency has required medical educators to create an online learning package to replace face-to-face teaching to support students in their selfdirected studies.
Background
In Tayside the number of women receiving GA for operative delivery is increasing. For pregnant women GA is associated with difficulties in airway management, aspiration and increased maternal mortality.
Aims
To determine the rate of GA for operative delivery, the indications for GA and complications associated with GA.
Methods
All women who delivered in NHS Tayside in 2013 were included. Information for women who had GA for operative delivery was obtained from the maternity notes and the local maternity database (Torex Protos Evolution, v3.5.19).
Results
81/4316(1.9%) women had GA for delivery. 80/81(98.8%) had caesarean section (CS).
The most common indication for GA was category 1 CS (45/81, 55.5%). 129 women had category 1 CS and 45/129(34.9%) had GA. 18/81(22.2%) had GA for unsuccessful regional anaesthesia. 3 women converted to GA because of intra-operative pain. 8/18(44.4%) who had unsuccessful regional anaesthesia had BMI >25 kg/m2 and only 1/18(5.6%) had BMI >40 kg/m2. 5/81(6.2%) requested GA for delivery.
2/81(2.5%) had complicated intubations and 3/81(3.7%) developed pneumonia.
Conclusions
It is widely accepted that GA is used for operative delivery where there is insufficient time for regional anaesthesia or in situations where regional techniques are contraindicated. In our population the majority of women who require Category 1 CS have this procedure with regional anaesthesia. There were a range of indications for the use of general anaesthesia, including patient preference. Although the complication rates in our population are low, GA is a high-risk intervention and should only be used for operative delivery when it is clearly indicated.
Aims
To identify women who had cervical cerclage in Ninewells Hospital, Dundee and the indications for cerclage. Furthermore to assess techniques used, whether tocolysis was administered and to examine pregnancy outcomes for these women.
Methods
Women who had cervical cerclage between January 2004 and September 2010 were identified from the maternity theatre records. The maternity case notes and the local maternity database were used to obtain information about the procedures and pregnancy outcomes.
Results
27 women had 29 pregnancies that required cervical cerclage. 14/29 (48%) were elective procedures and 15/29 (52%) were emergency procedures. All women that had elective cerclage had a history of previous mid-trimester spontaneous abortion and all women that had emergency cerclage had clinical or ultrasound evidence of cervical shortening and/or dilatation. The McDonald technique and Mersilene tape were used for all cases. Tocolysis was used in 20/29 (70%) cases (elective=7/14 (50%) vs emergency=13/15 (87%)).
The median gestational age of pregnancy outcome was 31 weeks (range=12–41 weeks) (elective=23 weeks vs emergency=34 weeks). 8/29 (28%) women had spontaneous abortion before 24 weeks gestation (elective=2/14 (14%) vs emergency=6/15 (40%)). 11/29 (38%) women delivered between 24 and 37 weeks gestation (elective=6/14 (43%) vs emergency=5/15 (33%)) 10/29 (34%) women delivered at Term (elective=6/14 (43%) vs emergency=4/15 (27%)).
Conclusions
In our unit cervical cerclage is performed infrequently. Nevertheless there is consistency in the surgical techniques used for both elective and emergency procedures. Tocolysis is administered more frequently for emergency procedures. For emergency cerclage the majority of women will either miscarry or deliver before Term. Outcomes appear to be better for elective procedures.
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