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Management of Parturients Who Decline Blood Transfusion OAA National Survey 122

Management of Parturients Who Decline Blood Transfusion OAA National Survey 122 A Jennings & C Brennan. Introduction. Increased morbidity and mortality Require particular management. Methods. OAA National S urvey 122 Sent to lead obstetric anaesthetists. Survey Objective.

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Management of Parturients Who Decline Blood Transfusion OAA National Survey 122

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  1. Management of Parturients Who Decline Blood Transfusion OAA National Survey 122 A Jennings & C Brennan

  2. Introduction • Increased morbidity and mortality • Require particular management

  3. Methods • OAA National Survey 122 • Sent to lead obstetric anaesthetists

  4. Survey Objective • To establish current UK anaesthetic practice when managing JWs • Consent • Pre-optimisation • Anaesthetic technique • Facilities available • Seniority of staff involved

  5. Response rate 70%

  6. Antenatal Care Majority • Have a policy – 85% • Use specific “no blood” consent form – 85% • See patients in clinic – 70% Minority • Routinely administer prophylactic haematinics – 36% • Erythropoietin (if anaemic) – 20%

  7. In a ‘High Risk’ LSCS…

  8. Senior Input What is deemed mandatory in all cases? • Consultant anaesthetist-led theatre care: 30% • Consultant obstetrician-led surgery: 24% • Consultant haematologist notified: 23%

  9. Facilities– Cell Salvage ‘Continuous connectivity’ mode • Discuss antenatally: 53% • Provide a 24hr service: 21% • No cell salvage at all: 25%

  10. Facilities– Interventional Radiology 24-hour access to interventional radiology service: 27%

  11. Postnatal Syntocinon Infusion Routine use in: • Caesarean Section: 48% • All forms of delivery: 22%

  12. Centralisation of Services? • 42% felt JWs should be managed in specified regional centres where appropriate facilities, staffing and expertise are guaranteed 24-7.

  13. Conclusion • Substantial variation in management demonstrated • Many units are not equipped to meet the JW care plan • Substantial support for centralisation of services for JWs. This is worthy of further discussion.

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