Indications for Obstetric Consultant Attendance in Maternity Unit

Introduction

The positive effect of direct consultant care is recognised. There should be no hesitation to call Consultants to the Maternity Unit. Consultants should respond positively to requests for assistance.

A request to attend should be communicated clearly, the request should be documented on Badgernet and the use of an SBAR is recommended. If consultant input is required, this should happen before a management plan is discussed with a woman.

Attendance in person

In the following situations, the consultant should attend in person. (although starting a procedure in theatre should not be delayed whilst waiting for the consultant to arrive).

• Eclampsia
• Cord prolapse
• Maternal collapse ( such as massive abruption, septic shock)
• Life threatening maternal condition (such as amniotic fluid embolism)
• Any women who require ITU transfer
• Severe maternal compromise MEWS >4
• Postpartum haemorrhage of more than 1.5 litres when the haemorrhage is continuing and a MOH protocol initiated
• Return to theatre
• Trial of Forceps in theatre
• Instrumental birth in women with BMI greater than 50
• Vaginal twin births
• Vaginal breech birth
• Caesarean birth when cervical dilatation is 8cm or more
• Caesarean birth in women with BMI greater than 50 ( and should be considered for lower BMI depending on experience level of operating surgeon)
• Caesarean birth after intrauterine death has occurred
• Caesarean birth for transverse lie
• Caesarean birth for placenta praevia – if the placenta is not known to be low lying and is in the lower segment on incising the uterus the Consultant should be called
• Caesarean birth for APH
• Caesarean birth when previous bowel surgery
• Caesarean birth at less than 34 weeks gestation
• Caesarean birth for women declining blood products (although would normally be delivered in RIE)
• Uterine Rupture
• Fourth Degree perineal tear
• Unexpected intrapartum stillbirth
• Preterm birth with pathological fetal monitoring
• When requested for any reason

Attendance in person

If the trainee has not been signed off as competent for a procedure, such as -

• Caesarean birth where the woman has had 3 or more previous caesarean sections and also consider if 2 or more CS with high BMI
• Third degree perineal tears
• Manual removal of placenta

Situations where Consultants should be informed

In the following situations the consultant should be informed and a decision whether direct review or advice is appropriate should be made depending on each case. There should be a low threshold for attendance and direct contribution to care.

• Any intrauterine transfer (either in or out; discussion prior to decision)
• Preterm labour less than 32 weeks
• Severe pre-eclampsia- requiring IV therapy
• Severe antepartum haemorrhage

Other factors

There will be instances when consultant input is required due to high levels of clinical activity, rather than a single complex case. Where there are multiple factors present that overall increase the difficulty of a case the consultant should be called. Senior midwifery staff or other medical staff should contact the consultant directly via mobile or home phone number, situated in Labour Ward. Consultants should be called to help if any clinical situation where their direct input to care would potentially improve the outcome for the mother and baby.