Fetal Pillow at full dilatationMichael Beckmann Huda Safa

Background• Deeply engaged fetal head

• 1-2% of CS • Associated with adverse maternal

and neonatal outcomes

• RANZCOG guideline

• Fetal Pillow • Mater Health Services first unit in

Australia • 2 fetal deaths subject to Coronial

Investigation

Objective

Report the initial Australian experience with use of the Fetal Pillow

Methods• Retrospective cohort study

• Women who underwent CS at full dilatation • Between May 2013- March 2015 • Mater Mothers Hospitals, South Brisbane

• Data extracted from electronic maternity record

• Comparison• Cases where the FP method was used• Cases where the hand–push method was used • Maternal and neonatal outcomes reported

Results• 361 CS performed at full dilation

• FP-method 91 cases • Hand-push method 69 cases• Similar baseline characteristics

Fetal Pillow Hand-push P-value

Nullipara 82% 66% 0.15

Age 30y 31y 0.39

BMI 25 24 0.61

Gestation 40 40 0.54

Category 1 CS 49% 52% 0.95

Failed instrument 6% 4% 0.54

Results• Women in whom the FP-method was used

• Shorter post-partum length-of stay • Higher cord arterial pH • Less EBL• Other outcomes similar

Fetal Pillow Hand-push P-value

Apgar <7 @ 5 minutes 3% 6% 0.44

Intubated 0% 3% 0.10

Nursery admission 15% 25% 0.14

Cord arterial pH 7.24 7.19 0.02*

Mean EBL 273ml 403ml 0.03*

Blood transfusion 3% 3% 0.71

Angle extension 20% 34% 0.09

Post-partum LOS 78h 98h 0.01*

Conclusions• Initial findings

• confirm others experience • effective aid when deeply impacted fetal head • larger numbers are needed

• Clinician feedback universally positive

• Risk minimisation