Authors (including presenting author) :
Chan HK(1)
Affiliation :
(1)Obstetrics and Gynaecology Department, Queen Mary Hospital
Introduction :
Historically, all the extremely high risk obstetrics surgical cases,e.g. case with morbid placenta accreta & percreta, cancer and severe medical/surgical disease complicated pregnancies...etc., were operating in hospital main OT rather than in delivery suite attached operating theatres. The reasons behind were inexperience and incompetencies of midwives in assisting high risk obstetrics surgical case in the delivery suite OT; insufficient equipment and instrument support for special cases; and easy access of anaesthetists and surgical experts within hospital operating theatres. To a certain extend, this did create stress on gynae operating list when increasing number of complicated high risk cases being referred to QMH as we have to block the gynae OT list for the obstetrics cases. Besides, there was also manpower implication to the obstetricians and midwives when 2-3 obstetricians and 2-4 midwives had to mobilize to hosptial main OT for at least 2-4 hours in performing / assisting OT and resuscitating the newborn. This in turn created another stress to delivery suite manpower, especially during emergency situation when extra manpower were not planned ahead. Furthermore, midwives also needed to spare time in gathering all the essential equipment and instrument to hospital OT in advance for elective case or within a short period of time for emergency case. Safety of mother and fetus were not guaranteed in case of severe antepartum haemorrhage or fetal distress when midwives needed time to prepare everything and transport to hospital OT which is located in another block of the hospital. In view of the above,consideration was sought to relocate less complicated case,e.g. placenta accreta or cancer complicated pregnancies with single organ involvement, back to delivery suite OT.
Objectives :
1. To reduce stress and disturbance in Gynae OT session 2. To re-distribute resource allocation between hospital and delivery suite operating theatres 3. To fully utilize resources and manpower in delivery suite operating theatre 4. To enhance midwives' competencies and experiences in handling complicated obstetrics surgical cases especially when deterioration of surgical case is normally unexpected 5. To promote safety of mother and fetus when delivery is imminent and cannot bear to wait for more than 30 minutes after decision of cesarean section was made
Methodology :
1. Obtaining assistance from gynae team medical officer for video taping of trolley setting and procedure of hysterectomy done in main OT 2. Developing a training and coaching program for midwives with advise from obstetrics consultant in-charge 3. All midwives working in delivery suite operating theatre have *self-learning from (1) video; *simulation training with return demonstration on a) Trolley setting of hysterectomy and assisting hysterectomy procedure; b) Airway management; c) Post-partum haemorrhage management, including activation and deactivation of obstetrics massive transfusion protocol (MTP), organising uterine artery embolization (UAE) in theatre / X-ray department
Result & Outcome :
1. Midwives are competent in handling complicated obstetrics surgical cases in delivery suite operating theatre 2. Booking of high risk obstetrics surgical cases, such as placenta accreta without other organ(s) involvement; Gynae localized cancer complicated pregnancy, in delivery suite operating theatre 3. Minimize disturbance of Gynae OT list after considered all the essential factors 4. No adverse outcome being detected in these cases after OT done in obstetrics side.
After 1.10.2018, all high risk obstetrics surgical cases with single organ involvement were booked under OBS theatres. As at 31.12.2018, there were totally 2 cases, one with simple accreta and the other with CA cervix, booked and had caesarean section and hysterectomy done in delivery suite operating theatre. No adverse outcome was detected. Midwives, obstetricians and anaesthetists were satisfied with the fine tuned workflow and team work.
Co-location with:
