Advanced Obstetrics
Structure of Module
Daytime duties on delivery suite 08:00 - 18:00 alongside a consultant and another trainee or SAS doctor. The emergency and elective workload is split between all team members, there is not a dedicated ‘elective’ team.
Attendance in clinics, labour ward forums and audit meetings can be arranged in EDT time or on your rostered advanced obstetric days.
Typical Day
Anaesthetic handover happens at 08:00 in the anaesthetic office unless the night anaesthetist is in theatre. Emergency drugs and machine checks should be done at the start of the day. The board round begins at 08:30; if possible see one of the elective sections prior to going to board round. It is co-ordinated by the Band 7 or 8 midwife and attended by obstetric and anaesthetic doctors, neonatal nurse, maternity ward midwife, birth unit midwife and stroud birth unit midwife. It is followed by an MDT ward round.
The elective section list takes place in Theatre 2. There is a WHO meeting for all the patients who have been seen in the anaesthetic office or theatre. There are normally 4-5 elective sections and there is staffing for the elective list until 16:00.
Emergency cases happen in Theatre 1.
The epidural trolleys are stocked by the MCAs and should have everything needed for an epidural.
Gloucester has fully adopted NR fit equipment for all neuraxial blockade (and soon to be all regional anaesthesia).
All patients having an anaesthetic intervention get a patient sticker and anaesthetic details written in the follow-up book and then get added to the anaesthetic database. Follow-ups are done in the afternoon and are cleared from the anaesthetic database. If they become complex follow-ups there is an additional form to complete within the database and they should be added to the complex follow-up folder.
Meetings and clinics
- Maternal medicine
Try to arrange attendance at one or two maternal medicine clinics. They run on Monday and Wednesday mornings at GRH or Tuesday afternoons at CGH.
Mandy Finnigan is the rota co-ordinator and will ensure the clinics are not oversubscribed with obstetric trainees, but it is good to drop a courtesy e mail to the consultants that run the clinics to ask if they mind you joining. Mr. Hayman, Dr. Swingler and Dr. Elbeshir. All of whom are very friendly and approachable.
- Fetal medicine clinic
Friday mornings in GRH, Tuesday mornings in CGH
- Cardiac clinic
Contact Johanna Trinder at St. Michaels hospital. This clinic is often oversubscribed with trainees so get in touch early They happen on the 1st and 3rd Friday of the month.
- Labour Ward Forum is on the 2nd and 4th Friday of every month at 12:30 – 14:00, Seminar room in Women and Children’s Centre admin corridor.
- Obstetric Risk Management Meeting happens on the 1st and 3rd Friday of every month in the seminar room, 09.30-11.30, Women and Children’s Centre admin corridor. Leanne McDermott is the obstetric lead. The 3rd Friday is specific to PPH but both are interesting.
- Obstetric clinical governance/audit meeting is on the 1st Friday of the month at 14:00 in the Seminar Room, Women and Children’s admin corridor.
- High Risk Anaesthetic clinics take place in general outpatients:
Sarah Muddle: Tuesday morning weeks 1,3,5
Cath Bryant: Weds afternoon, week..
Tom Knight: Friday morning week 3
PROMPT Training
If you are not up-to-date with PROMPT training it can be booked via ESR. Annual compliance mandated by the Trust.
If you would like to teach on the PROMPT course e mail Lisa Hill lisa.l.hill@bristol.ac.uk who is the undergraduate student administrator for reproductive health and care of the newborn. PROMPT training in GRH takes place every month - always need help with teaching! Email ghn-tr.maternity.practicedevelopment@nhs.net
Shadowing
It is worth spending some time shadowing members of the team allied to Delivery Suite to gain a better understanding of their point of view in obstetric management and aid multidisciplinary team working.
- CDS registrar
- Elective caesarean surgeon – scrub in and assist in LSCS
- Neonatal registrar
These are best arranged ad hoc on a day when anaesthesia is well staffed (this happens more often than you think!) and with a member of the obstetric team you have worked with before. They are a friendly bunch and often delighted to have an anaesthetic shadow for the day. If you wanted a more formal method I’ve been advised Dr. Swingler may be able to facilitate this with the obstetric registrars if you e mail her.
Cell Salvage
Cell salvage is used for all emergency LSCS and any high-risk elective LSCS. It is run by the MCA in theatre. Please chat to Donna Davis, Blood Conservation Coordinator if you want to find out more. For training and competency with cell salvage there is an online package with a cell salvage module:
http://www.learnbloodtransfusion.org.uk
Secondment to Queen Charlottes Hospital
For more experience at a tertiary centre Sophie can arrange an observership at Queen Charlottes Hospital in London via Gary Stocks. If you are interested let Sophie know early on as it does take some time to arrange. This is a very interesting week with attachment days to labour ward, maternal medicine clinic, fetal medicine clinic and high risk obstetric anaesthetic clinic. They see a broad mix of complex cases and it’s a really worthwhile experience.
Obstetric Anaesthesia Team
Consultant anaesthetists
Jo Collins - clinical lead in obstetric anaesthesia
Sophie Scutt - educational module lead
Laura Beard – education module lead
Alex Day
Cath Bryant
David Gabbott
Debbie Burton
Henry Murdoch
Kath Sutherland
Louise Sellar
Mandy Rees
Mark Eveleigh
Martina Nejdlova
Neil Kellie
Nishi Patel
Sarah Muddle
Sock Koh
Ted Rees
Tom Knight
SIA Lead: