[CG] Indications for Obstetric Consultant attendance in Labour Ward

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Patient safety and quality of care is the priority.

The positive effect of direct consultant care is recognised. Consultant work patterns have been altered to facilitate their contribution to acute Obstetric care. There should be no hesitation to call Consultants to the Labour Ward area and Consultants should respond positively to requests for assistance.

A request to attend should be communicated clearly, in a structured way (e.g. by using SBAR). The request should be documented in the notes. If consultant input is required, this should happen before a management plan is discussed with the woman.

Attendance in person

In the following situations, the consultant should attend in person, whatever the level of the trainee:

  • Eclampsia
  • Maternal collapse (such as massive abruption, septic shock)
  • Postpartum haemorrhage of more than 1.5 litres where the haemorrhage is continuing and a MOH protocol has been instigated
  • Return to theatre – laparotomy
  • Caesarean section for major placenta praevia.
  • Vaginal Twin deliveries
  • Vaginal breech delivery
  • Instrumental delivery in women with BMI greater than 50
  • Caesarean section in women with BMI greater than 50
  • Caesarean section after intrauterine death has occurred
  • Caesarean section for transverse lie
  • Caesarean section at less than 30 weeks gestation
  • Uterine rupture
  • Fourth Degree tear
  • When requested for any reason

Attendance in person or immediately available

For the procedures listed below, the consultant should attend in person or should be immediately available (i.e. present on labour ward) unless the trainee on duty is an ST7 and has been assessed by the unit and signed off, by OSATS where these are available, as competent for the procedure in question:

  • Full dilatation caesarean section
  • Trial of forceps / vacuum
  • Rotational Forceps
  • Caesarean section at 30-34 weeks gestation
  • Caesarean section where the woman has had 3 or more previous caesarean sections
  • Third degree tear (trainees at other levels who have been assessed to be competent may perform these unsupervised.)
  • Any woman who requires transfer to ITU

Situations where Consultants should be informed

In the following situations the consultant should be informed and a decision whether direct review or advice is appropriate should be made depending on each case. There should be a low threshold for attendance and direct contribution to care.

  • Severe maternal compromise (MEWS >7)
  • Any woman admitted to an Obstetric HDU or ITU
  • An intrauterine transfer (either out or in; discussion prior to decision)
  • Preterm labour less than 30 weeks
  • Severe pre-eclampsia – requiring IV therapy
  • Severe antepartum haemorrhage (evidence of maternal or fetal compromise)

Other factors

There will be times when consultant input is required due to high levels of clinical activity, rather than a single complex case. Where there is multiple factors present that overall increase the difficulty of a case the consultant should be called.

Senior Clinical Teams must be aware that particularly complex cases may require input from more than one site. These cases are rare and are hard to plan for but in particularly challenging circumstances may include contacting individuals who are not on-call.

Senior midwifery staff or other medical staff should contact the consultant directly if it is considered that the clinical situation requires their input.

Consultants should be called for help if any clinical situation where their direct input to care would potentially improve the outcome for the mother and baby.

References

RCOG Good Practice Guideline No 8 - Responsibility of Consultant on call.

Last reviewed: 12 October 2017

Next review: 01 October 2022

Author(s): R Jamieson, C Bain Clinical Directors GGC

Approved By: Obstetric Governance Group