key: cord-0943115-4dns88fn authors: Sherwood, O.; Lee, J.; Dean, A.; Bryson, E.; Smith, C.; Millar, K.; Nguyen-Lu, N. title: P.65 Anaesthetic considerations and outcomes in 90 pregnant women with COVID-19: A prospective observational study date: 2021-06-09 journal: Int J Obstet Anesth DOI: 10.1016/j.ijoa.2021.103063 sha: 94df7717ee7b9bca18b5172f91a7cf102bdf9d6a doc_id: 943115 cord_uid: 4dns88fn nan Referrals to the high-risk anaesthetic antenatal clinic Discussion: Demand for clinic slots more than doubled in 5 years. The number of medical problems has also risen dramatically, with 44% of patients now having 2 or more problems compared to 9% 5 years ago. An increase in the number of women with a BMI>40 kg/m 2 puts additional pressure on delivery suites and elective caesarean lists as IV access, neuraxial blocks and operative delivery are more complex and time-consuming. Our unit has needed to rapidly adjust to the increasing demand and complexity of patients by adding additional clinics, training in ultrasound for neuraxial procedures, and more double time slots on elective lists for patients with high BMI or medically complex pregnancies. We anticipate that this trend will continue, with a similar picture seen in smaller centres within 5 years. References [1] . Public Health Agency. Confidential enquiry into maternal and child health: Introduction: The Mercy Hospital for Women, Melbourne has recently introduced a successful enhanced recovery after surgery (ERAS) for elective caesarean section program as evidenced by a reduced length of hospital stay. We know that the more adherent that patient care is to the ERAS protocol the better the patient outcomes. 1, 2 Knowing this, we wished to see how adherent our patients were to our ERAS for caesarean section protocol. Methods: Our ERAS for elective caesarean section protocol has 58 points. We wish here to focus on overall compliance to the protocol. We audited two groups; pre-implementation of ERAS group (pre-ERAS group) and the ERAS group. We looked at points in the pre-, intraand post-operative setting that were outlined in the protocol. These points focused criteria supported by the DREAM principles (drinking, eating, mobilising) which are key elements in many enhanced recovery programs. 3 Results: We had a total of 48 patients in the pre-ERAS group and 47 patients in the ERAS group. Discussion: Many studies looking at implemented ERAS programs for caesarean section take protocol-determined intervention results, such as time to urinary catheter removal, as outcome measures. We felt that this is not appropriate as we have pre-determined the timings for these interventions. From other studies, however, we do know that strict adherence to the protocols in a given ERAS program is an important factor in positive patient outcomes and program success. 1,2 Our ERAS program achieved its primary outcome of reduced length of stay. We have shown that our pre-determined interventions of the DREAM elements of pre-operative fluid fasting, use of two intraoperative antiemetics (data not shown), time to mobilisation and urinary catheter removal were significantly improved in the ERAS group, allowing us to positively assess compliance in this group and increasing the likelihood of positive patient outcomes. References [1] . Introduction: The coronavirus disease 2019 (SARS-CoV2) global pandemic has devastated the UK with a death rate that has reached >112 000 people. 1 We aimed to describe the risk factors, disease severity and anaesthetic input in a case series of COVID-19 positive pregnant women presenting to our inner London tertiary hospital. Methods: After trust approval was obtained, we conducted a singlecentre, prospective observational study over a ten-month period covering both waves of the pandemic from March 2020 to January 2021. We included all pregnant women with a positive polymerase chain reaction swab result for COVID-19. Data collected included demographics, comorbidities, disease presentation and severity, anaesthetic input with maternal outcomes. Results: Ninety women (1.6% total deliveries) were included. The mean age was 32.3 ± 5.4 years, body mass index 28.0 ± 6.2 kg/m 2 , 69% were from a Black, Asian and Minority Ethnic (BAME) ethnicity, 21.1% women had diabetes mellitus and 4.4% hypertension. Mean gestation was 30 ± 7 weeks. 46.7% presented to labour ward with COVID-19 symptoms, 25.5% of women were asymptomatic and picked up on routine screening. 63.3% of women did not require any respiratory support, but 14.4% women needed critical care. Eight (9%) were inter-hospital transfers for extra corporeal membrane oxygenation (ECMO). At the time of writing, 76 women (84%) had delivered (44.7% by spontaneous vaginal delivery and 44.7% by caesarean section). Of the 51 women (56.6%) who had an anaesthetic, 35.3% of women had an epidural (70.5% inserted at 4 cm or less and 55.5% topped up for use in theatre), 35.3% had a spinal anaesthetic and 9.8% had a combined spinal and epidural. Three (3.3%) women had a general anaesthetic (GA). Platelet count was on average 221 ± 86 × 10 9 /L. There were two intrauterine deaths. Discussion: This study identifies that BAME background, high BMI, diabetes and being in the third trimester are risk factors for COVID-19. Severity of disease was greater in our cohort than demonstrated by the recent UK Obstetric Surveillance System (UKOSS) data with 14.4% vs. 5% requiring critical care and 8.9% requiring ECMO (UKOSS <1% of symptomatic patients) explained by the nature of our tertiary referral institution with ECMO provision. 2 Early epidural insertion minimised respiratory complications and intraoperative conversion to GA which may explain our low GA rate. 3 Essential early escalation of respiratory support and a cohesive multidisciplinary approach led to the successful delivery of our COVID-19 positive women. P.66 A re-audit of epidural analgesia for labour at a tertiary maternity unit S.F. Higgin ⇑ , K. Whitehouse Obstetric Anaesthesia, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK ⇑ Corresponding author. Introduction: In May 2019 an audit of epidural analgesia in labour was undertaken at a tertiary maternity unit looking at patient comfort at 45 min from insertion and management of inadequate analgesia. 1 The results showed patient comfort at 45 min was only achieved in 59%, and a variable approach to inadequate analgesia was demonstrated. We implemented new paperwork to pick up ineffective epidurals sooner and issued new guidance to standardise epidural top-ups. Practice was then re-audited against local guidelines. 2 Methods: A retrospective audit was conducted at the same tertiary maternity unit of all epidurals sited during December 2020. The primary outcome was patient comfort (pain score <4) 45 min post-insertion. We also reviewed the management of epidurals when analgesia was inadequate. Results: One hundred and seven patients had an epidural sited during December 2020. Two patients had an accidental dural puncture during the procedure and an intrathecal catheter inserted; one patient had a CSE sited and four patients' notes were lost to follow-up so 100 patients were included in the data analysis. The primary outcome of patient comfort at 45 min post-epidural insertion was achieved in 71% (n = 71). 25% (n = 25) were not comfortable at 45 min, with 2% delivering within 45 min and 2% with inadequate documentation to ascertain comfort levels. 4% patients had a second epidural sited and 6% patients were never comfortable. Of the 25 patients who were not comfortable, the duty anaesthetist was asked to review 17 patients, and 16 top-ups were administered. 100% of top-ups administered were compliant with the new guidance. Discussion: Overall, patient comfort levels at 45 min post-insertion have improved (71% vs 59%) and administration of epidural top-ups has been standardised, with a lower number of patients (4% vs 9%) requiring a re-site epidural. However, for some patients, we are still not providing a satisfactory service. Further multidisciplinary team training is needed to recognise inadequate epidural analgesia and improve the labour experience for these patients. COVID-19) in the UK The incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2 infection in the UK from Obstetric Anesthesia During the COVID-19 Pandemic Epidural analgesia for labour The Newcastle Upon Tyne Hospitals NHS Foundation Trust. Epidural analgesia for labour pain relief clinical guideline 67 A review of fluid balance documentation in high-risk obstetric women on our maternal high dependency unit A. Sieunarine ⇑ , J. Lloyd-Evans, J. Stevens Grange University Hospital Anaesthetic Department, Aneurin Bevan Health Board, Newport, UK ⇑ Corresponding author.Introduction: Recently, there has been an increased awareness of the importance of preventing maternal hyponatremia and a growing number of case reports of associated peripartum maternal confusion and neonatal seizures. 1, 2 In 2017, GAIN produced guidelines for the management of hyponatremia in labouring women, 3 and guidelines for our Health Board were introduced on the basis of this, following a few cases of maternal and neonatal hyponatremia within our unit. Both guidelines highlight the importance of maintaining accurate peripartum fluid balance. However, on closer inspection of our maternal HDU service, we noted significant discrepancies and inaccuracies in our fluid balance and documentation.Methods: A retrospective evaluation of fluid balance documentation within our maternal HDU between the months of September to November 2020 was performed. The HDU monitoring charts were examined with focus on: previous fluid balance, running hourly input and output, cumulative input and output. The clinical notes were reviewed to look at documented reasons for admission to HDU, electrolyte abnormalities and duration of HDU admission.Results: A total of 30 patients were identified. They were all admitted to HDU postnatally. Ten patients were excluded due to missing notes. Of the remaining patients admitted to HDU, 11 had postpartum haemorrhage (blood loss >15% total blood volume), four had preeclampsia and five had maternal sepsis. There was no documentation