Princess Royal Maternity & Glasgow Royal Infirmary

08:30 – 20:45 - Handover at Midwife Station on Labour Ward

08:30 – 10:00 - Labour Ward & MAU

10:00 – 16:30 - Labour Ward

16:30 – 20:45 - Labour Ward & Obstetric Wards

On-call Obstetric Page 

•  Join the delivery suite ward round with the on call registrar and consultant.
• The obstetric ward cover is shared between the on call consultant and the second on obstetric consultant. 
• Liaise with the obstetric ward first on call doctor so that between you the work for the obstetric wards is completed.  
• Make sure you are logged into Badgernet and have a computer for results if needed on the ward round.
• Update the jobs book as you go.
•  You will take over the duties from the obstetric ward doctor at 16.30 so help each other. 

Duties of the Day

Your time will be split between

• Labour Ward
• Theatre

Labour Ward

• Typical duties include prescriptions, fluids, cannulas, ECGs, patient reviews.
• You will also be involved in Emergencies - Post-Partum Haemorrhage, Shoulder Dystocia and Pre-Eclampsia to name a few ...
• If you are called to an emergency, identify yourself and ask the registrar/consultant/Labour Ward Sister what you can do to help. Often this will be IV access, sending bloods, prescribing emergency drugs. It is good to have an understanding of how these emergencies are managed to appreciate what is happening and how best to contribute

Emergency Theatre - C-Sections or Instrumental Deliveries

• Category 1 - Immediate threat to the life of mother or baby - Decision-to-Delivery time = 30mins
• Category 2 - Urgent but no immediate threat to the life of mother or baby, often timing is dependant on Labour Ward pressures - Delivery time within 60 minutes 
  
  
• You will be paged from theatre to attend Emergency Caesarean Sections
• At this point the Spinal Anaesthesia is normally in and your presence is required immediately. 
• Make sure you are in scrubs, theatre shoes and have a theatre hat on before entering Theatre
• Before scrubbing, make sure there is gown and gloves open on the prep-table and you have a mask on (Normally, theatre staff are pretty good at getting this ready but often in an emergency it's up to you!)
• Scrub (presumed you can do this, if you need a refresher ask one of the midwives/theatre staff!)
• Assist in the C-section in the usual way, but be aware of the fact that the focus is on delivering the baby as quickly as possible so stay focused!

Immediate Discharge Letters

• IDLs needing completion are on a clipboard at the labour ward midwife station. It is your responsibility to write the IDL for the patients delivered on labour ward

Template for discharge letters:

Dear Doctor,

The above patient attended PRM to deliver her baby. The details are as follows:

Date of delivery –

Mode of delivery –

EBL –

Latest haemoglobin –

Maternal weight –

VTE risk –

Allergies –

Outstanding results –

Contraception -

Follow up: Yes – community midwife.

*Gestational Diabetics need a HbA1c 3-6 months at their GP*

Kind regards, 

 

Discharge medication:

LMWH (Enoxaparin) 

• Low Risk: No LMWH
• Intermediate Risk: 10 days LMWH
• High Risk : 6 weeks LMWH

Ferrous sulphate 200mg TID if latest Hb <110

Analgesia - See pharmacy hand-out

08:30 – 16:30

• Attend Labour Ward handover so you are aware of any unwell patients
• Get a handover sheet from the midwives on Ward 72 and make sure all the wards have your page number
• Cover Wards 73, 72 and 68
• Join the antenatal ward round first on 72 with the second on consultant. If there is no second on consultant the obstetric wards will be covered by the labour ward consultant. 
• Make sure you are logged into Badger and have a laptop for accessing results
• Update the Jobs Book as you go  

Immediate Discharge Letters

In general IDLs for post-natal patients will have been started by the Labour Ward team.

Template for discharge letters:

Dear Doctor,

The above patient attended PRM to deliver her baby. The details are as follows:

Date of delivery –

Mode of delivery –

EBL –

Latest haemoglobin –

Maternal weight –

VTE risk –

Allergies –

Outstanding results – 

Follow up: Yes – community midwife.

*Gestational Diabetics need a HbA1c 3-6 months at their GP*

Kind regards, 

**Some patients may have a more complex obstetric history and require more detail on the IDL. For example if they had pre-eclampsia in the antenatal period and still require anti-hypertensives this should be included. Make sure all the relevant information is included on the letter to the GP to optimise ongoing care.**

Discharge medication:

LMWH (Enoxaparin) 

• Low Risk: No LMWH
• Intermediate Risk: 10 days LMWH
• High Risk : 6 weeks LMWH

Ferrous sulphate 200mg TID if latest Hb <110

Analgesia - See pharmacy hand-out

Handover to the LW doctor at the end of your shift

Weekday Cover 

08:30 - 10:00 - First on call for labour ward 

10:00 - 18:00 MAU doctor (senior cover is obstetric registrar or consultant)

18:00 - 20:30 - First on call gynaecology  (senior cover is gynaecology registrar)

Weekend Cover

08:30 - 20:30 - First on-call gynaecology (senior is gynaecology registrar)

Nights 

08:30 - 20:30 - First on-call gynaecology nights (senior is gynaecology registrar)

Essentially A&E for pregnancy

• If a woman has had an USS showing a viable intrauterine pregnancy (normally a Booking Scan at 10-12 weeks) they will usually attend Maternity Triage as their first port of call for an acute complaint relating to their pregnancy

• Women can self-present or be referred by Community Midwives/GPs/A&E/ante-natal clinics. If they are unbooked they will need to be seen by EPAS or Gynaecology.

Patients will have a Midwife assessment before you see them, consisting of;

• Maternal Observations
• Abdominal Examination
• Fetal Assessment (CTG if >26 weeks, FHR if <26 weeks)

• We do not expect any of you to be experts in obstetrics and therefore we expect that initially you will need a lot of support and supervision from the registrar/consultant 
• Please do not examine / make a plan if you are not confident with what you are doing – someone will always be there to help

Common Presentations

Women will present with a large range of clinical problems, some warranting admission or delivery (this will not be your call!) and others requiring simple investigations, risk assessment and reassurance +/- plans for follow up.

Below are a few of the most common presentations and important diagnoses to think about;

Headache

• Extremely common in pregnancy due to hormonal change, stress and poor sleep
• Exclude dehydration
•  Severe headaches can be a sign of Pre-Eclampsia so be sure to exclude other symptoms including visual disturbance, epigastric pain, oedema. Always check BP and urine for protein
• Common things are common, but make sure you take a good history and exclude any Red Flag symptoms; first & worst, sudden onset, neurological disturbance, postural link, systemic features of infection/inflammation

Abdominal Pain

Again, very common due to stretching of abdominal wall and displacement of intra-abdominal organs

• Exclude regular uterine activity (contractions) and anything to suggest premature labour (backache, pelvic pressure and vaginal discharge)
• Exclude associated PV Bleeding
• Exclude any abdominal trauma and check Rhesus status
• If epigastric, any other signs of Pre-Eclampsia?
• If suprapubic, any associated urinary symptoms to suggest UTI?

Don't forget appendicitis, gallstones and constipation ... pregnant women can still have these!

Shortness of Breath

Oxygen consumption and tidal volume are increased in pregnancy and it is extremely common for women to feel a subjective shortness of breath, especially in the third trimester where the diaphragm is compressed by the enlarging uterus

• Exclude infectious causes
• Any other suggestive features of Pulmonary Embolus (pleuritic chest pain, calf swelling/oedema, risk factors, tachycardia, low SpO2) - Obstetrics generally has a low threshold for investigating PE's due to their relatively high morbidity/mortality index

Infections

• UTIs - very common * Can stimulate pre-term labour so always treat if you suspect a UTI*
• LRTIs - common and can be more serious in pregnant women due to physiological changes and relative immunosupression
• Sepsis - be on hot alert for Sepsis! If someone meets the criteria, perform the SEPSIS 6 and escalate accordingly

PV Bleeding and Discharge

• Multiple causes for PV Bleeding; exclude Placenta Praevia, Placental Abruption, Vasa Praevia as these are serious and will often need urgent management
• Rule out associated pain, ensure patient happy that there has been no change in fetal movements
• Has the bleeding been provoked ? Post-intercourse/ ? Abdominal trauma
• Is the discharge 'Show'? Ruptured membranes? Odorous?

Obstetric specific problems will usually be seen by registrar, always discuss if you are unsure

Antenatal admissions will go to Ward 72

Postnatal admission will go to Ward 68 or Ward 73

Unwell patients may need to go to Labour ward or HDU

Day care unit

Weekdays 09:00 – 17:00

• Higher risk obstetric patients who are seen more regularly for BP monitoring or CTG monitoring etc.
• Usually covered by day care midwives and on call obstetric reg and consultant
• May be asked to site cannulas for ferrinject or to take bloods
• May be asked to review patients (DCU midwives will usually come to speak to you or put this on the board)

EPAS (Early Pregnancy Assessment Service)

Weekdays 09:00 – 17:00

Some weekend cover (shared with QEUH)

• Manages pregnancy of unknown location, or pain and bleeding in early pregnancy
• May be asked to take blood or review someone who does not feel well
• May be asked to prescribe medical evacuation medications for women who have had a miscarriage
• Senior cover is the gyn reg/ consultant

• Can be a variable workload. Call for help from people covering Gynaecology (56B or theatre) or first on call for Labour ward

20:30 – 08:45 - Handover at Midwife Station

• Join Labour ward Ward Round with the registrar/ consultant
• Help in MAU if needed
• Help your night gynaecology colleague with the phlebotomy round
• Tea and toast at 6am on labour ward!

08:30 – 16:30

Obstetric trainees will need to attend earlier to see the patients pre-operatively, make sure they are consented +/- scanned if required.

• Go to Ward 71 (6th Floor) to see pre-operative patients. The theatre list is usually at the nurses station on W71. Some women may be on W72 if they are already inpatients. 
• Introduce yourself to the patients their partners so that they know who you are prior to the procedure
• Attend the Theatre Brief at 08:45 in Theatre 1 Anaesthetic room
• Assist the consultant or registrar with elective caesarean sections
• Complete the VTE risk assessment after each case
• In between cases it is your responsibility to do the IDL for the elective theatre cases. 
• Don't forget to email [email protected] if women are having a mirena/ copper coil inserted at the time of section. 
• If you are keen to learn and practice suturing/operating make yourself known!

Immediate Discharge Letters

Template for discharge letters:

Dear Doctor,

The above patient attended PRM to deliver her baby. The details are as follows:

Date of delivery –

Mode of delivery –

EBL –

Latest haemoglobin –

Maternal weight –

VTE risk –

Contraception - If having coil fitted email Sandyford: [email protected]

Allergies –

Outstanding results –

Follow up: Yes – community midwife.

*Gestational Diabetics need a HbA1c 3-6 months at their GP*

Kind regards, 

Discharge medication:

LMWH (Enoxaparin) 

• Low Risk: No LMWH
• Intermediate Risk: 10 days LMWH
• High Risk : 6 weeks LMWH

Ferrous sulphate 200mg TID if latest Hb <110

Analgesia - See pharmacy hand-out

08:30 – 20:45 - Handover at Nurses Station 

Weekdays

1st on-call, registrar or consultant (or both)

08:30 – 16:00 - Cover Ward 56A

16:00 – 18:00 - Cover 56A, 56B

18:00 – 20:30 - Cover 56A, 56B, MAU

Weekends

1st on-call, registrar and consultant

Carry your own page and write your number on the board 

• 56A - Emergency and Elective patients 
• Consultant Ward Round +/- Outliers in HDU/ITU
• Complete ward round and tasks 
• Chase swabs, urine cultures or any other outstanding investigations from previous emergency admissions on Trakcare. Patients may need notification letters. Once the result is actioned sign this results off Trak. This needs doing daily and is audited. Do not sign off pathology.
• Request bloods/imaging for following morning as per plans 
• Review post op plans and update handover sheet
• Print out new version of handover sheet for night team. Remember to add in outliers in HDU or ITU.

Referrals

• Referrals from A&E and GPs referred  to receiving registrar/consultant 
• Keep the 'Receiving Board' up to date with accepted referrals
• New patients usually seen by the registrar/consultant but you can ask to clerk first if you are keen
• Use the gynaecology proforma for your clerk in
• Patients assessed in the treatment room
• USS scans can be organised for the same/following day - discuss with the Consultant

08:00 – 16:00

GRI is a tertiary centre so patients can be complex and un-well following extensive operations. You will usually work here for a few days in a row to ensure continuity for these complex patients.

• The first hour usually the busiest.
• Theatre lists are in folders in 56A and 56B Nursing Stations
  • Clerk and take bloods from patient admitted for elective operations that morning. If both theatres running can be very busy so work together with Gyn Theatre person!
  • Make sure each patient has a clerk-in, kardex, VTE assessment
  • Check that each patient has 2 valid G&S samples on the system (most patients will require a sample on the morning of their procedure)
• Ward rounds are variable depending on the Consultant; sometimes the ward round is completed first thing, others will do the round later in the day
• If there is no Consultant allocated to the Gynae-Oncology ward round, the on-call consultant should do this, they may need a reminder ...
• Post-op plans will usually be specific, check these and act on them. If gyn-onc post op patients require daily bloods then make sure that these are requested on a daily basis until otherwise informed.  
• Ensure blood requests are completed for the following day
• Help out the 56A doctor if you are able

0800 – 1600

• First hour usually the busiest
• Theatre lists are in folders in 56A and 56B Nursing Stations
  • Clerk and take bloods from patient admitted for elective operations that morning. If both theatres running can be very busy so work together with 56B person!
  • Make sure each patient has a clerk-in, Kardex (sign the front to say you have done the Med-Rec), VTE assessment
  • Check that each patient has 2 valid G&S samples on the system (most patients will require a sample on the morning of their procedure)
• If you are required to assist in theatre the team will page you but you are welcome to attend even if you are not needed
• In between cases help with outstanding jobs on 56A and 56B and chase results on Trak.

20:30 – 08:45 - Handover at Nurses Station on 56A 

• Cover 56A, 56B and MAU
• You will need to do the Phlembotomy round at 6am
• Update handover and print out new copy for day shift
• May be required to attend Labour Ward if there is an emergency. 

PRM Gynaecology Clinics 

	Monday	Tuesday	Wednesday	Thursday	Friday
am		General Gynaecology - Dr Meadley General Gynaecology – Dr Bain	Gyn-Oncology MDT	General Gynaecology - Dr Wong	Scan - Dr Wong
pm	General Gynaecology - Dr Jamieson

 

Stobhill Gynaecology Clinics

	Monday	Tuesday	Wednesday	Thursday	Friday
am	Uro-Gynaecology - Dr Matthew One Stop - Dr Jamieson, Dr Bain	Uro-Gynaecology - Dr Perera One-Stop - Dr Wong MVA - Dr Kumar Nurse-Led Pessary Clinic	One Stop - Dr Bain	One Stop - Dr Sassarini, Dr Meadley, Dr Vella	General Gynaecology - Dr Perera Vulva Clinic/ Colposcopy -  Dr Vella  Colposcopy - Dr Kumar
pm	One Stop/Colposcopy - Dr Burton One Stop - Dr Mathew Scan - Dr Kumar	One Stop - Dr Mathew Colposcopy - Dr Kumar Vulval - Dr Siqqiqui	Gyn-Oncology - Dr Burton, Dr Lindsay, Dr Siqqiqui One Stop - Dr Wong, Dr Quaranta	General Gynaecology - Dr Owen  One Stop - Dr Nausheent, Dr Meadley Myosure - Dr Wong  Colposcopy - Dr Mathew	One Stop - Dr Nausheen  Nurse-led Pessary Clinic

 

New Victoria Hospital

Tuesday PM - Menopause - Dr Sassarini 

PRM Obstetric Clinics

	Monday	Tuesday	Wednesday	Thursday	Friday
am	ANC - Dr Scott USS - Dr Bradnock	Diabetes - Dr Scott, Dr MacKenzie USS/Procedures - Dr Kemaghan, Dr Brace	Medical Obstetrics - Dr Duncan, Dr Ellis USS - Dr Owen	ANC - Dr Kemagham, Dr McMillan SNIPS - Dr Ellis, Dr Wilson	ANC - Dr MacKenzie, Dr Nausheen  USS - Dr McMillan
pm	ANC - Dr Owen Twins - Dr Kemaghan, Dr McMillan	ANC - Dr Mathers USS - Dr Duncan Obs risk meeting 14:00	ANC - Dr Duncan	ANC - Dr Brace, Dr Bradnock SNIPS - Dr Ellis, Dr Wilson	USS - Dr Scott

Portfolio

• Educational supervisors will be allocated at the beginning of the block
• Keep ahead with your Portfolio, check what is required and get started early!

Junior Teaching

• Thursday Lunchtime – 12:45 to 13:30 in level 2 seminar room (next to MAU) or via Teams.
• Teaching programme will be provided at the start of the block.
• Record of attendance will be kept and a certificate detailing the sessions attended will provided at the end of the block.

Departmental Teaching 

Friday afternoon

A calendar of teaching events is available here

Queen Elizabeth Building 

Lower ground floor

• Main theatres (General surgery and CEPOD list)
• Exit to Wishart Street (Ambulance entrance)
• Security desk
• Canteen
• Link corridor to main hospital

Ground floor

• Access to Accident & Emergency
• Reception
• Aroma café
• WHSmith
• Townhead medical practice
• Townhead pharmacy
• Mabels café (leading to Clinic area A at GRI)
• Link corridor for bicycle storage
• Indoor access to the library in the Lister Building

Level 1 - Gynaecology

**Only one staircase goes to Gynaecology. Access otherwise from Alexandra Parade

• 56A – General Gynaecology
• 56B – Gynae-oncology
• Gynaecology Theatres (4 and 5)
• Gynaecology Theatre Tea Room
• Staff changing (showers and toilets)

Level 2

• Maternity Assessment Unit (Triage)
• Maternity outpatients (ANC and SNIPS) 
• Day-care unit
• Maternity Ultrasound department
• EPAS

Level 3

• Labour ward (rooms 1 – 12)
  • 1-8 - Labour Rooms
  • 9-10 - Low Risk Rooms (also used as COVID isolation rooms). 
  • 11-12 - Sensitive Labouring Rooms - Stillbirth, ToP, Fetal anomalies
• Ward 68 (Post-natal)
• Obstetric theatres (1-3)
• Labour ward tea room

Level 4

• Consultant offices
• NICU
• SCBU

Level 5

• Urology

Level 6

• Ward 72 – Antenatal
• Ward 73 – Postnatal 
• Ward 71 (also known as W73 assessment area) – Pre-operative ward for patients for elective LSCS

PAGE NUMBERS:

• Obstetrics First On Call – 10054
• Obstetrics Registrar – 10055
• Obstetrics Consultant – 10056
• Obstetrics 2^nd on Consultant – 10053
• Labour Ward Anaesthetic Consultant – 12205
• Labour Ward Anaesthetic Registrar - 12266
• Gynaecology Registrar/Consultant - 12216

TELEPHONE NUMBERS:

LEVEL	DEPARTMENT		INTERNAL	EXTERNAL
1	Ward 56A Gynaecology	Nurses station	13371/13372	0141 201 3371/2
1	Ward 56A Gynaecology	Portable phone	85556	0141 451 5556
1	Ward 56B Gynaecology	Nurses station	13363/13364	0141 201 3363/4
1	Ward 56	Doctors office	13366/13367	0141 201 3366/7
2	Antenatal clinic		13418/13422	0141 201 3418/3422
2	Daycare		13456/13457/13458	0141 201 3456/7/8
2	Maternity assessment	Staff base	13452/13453/13454	0141 201 3452/3/4
2	Maternity assessment	Clerkess	13450	0141 201 3450
2	EPAS		13447/13448	0141 201 3448
2	Ultrasound		13500	0141 201 3500
2	Community midwives		29812/29813	0141 242 9812/3
3	Ward 68	Staff base	13470/13472	0141 201 3470/2
3	Labour ward	Staff base	13302/29814	0141 201 3302, 0141 242 9814.
3	Labour ward	Clerkess	13303	0141 201 3303
3	Labour ward	Recovery	65494	0141 201 5494
3	Labour ward	HDU	29818	0141 242 9818
3	Labour ward	Theatre 1	13311/29827	0141 201 3311, 0141 242 9827
3	Labour ward	Theatre 2	13322	0141 201 3322
3	Labour ward	Tea room	29815	0141 242 9815
4	Kathleen McGrath	Directorate office	13334	0141 201 3334
4	Fiona McManus	Directorate office	13335	0141 201 3335
4	NICU		56356	0141 211 6356
6	Registar room (ward 71)		29786/29787	0141 242 9786/7
6	Ward 71 (elective CS)		13545	0141 201 3545
6	Ward 72		13550/13551	0141 201 3550/1
6	Ward 73		13547/13549	0141 201 3547/9
6	SNIPS office		13494	0141 201 3494