Andrew Follows, Kim Russon, Anupama Saxena, Amy Thomas, Archana Panickar, Lisa Stanhope, Olanike Bika, Tammy Hayward, Louise Price
The Rotherham NHS Foundation Trust, Rotherham, United Kingdom
Introduction: Cervical cerclage remains one of the standard interventions prophylactically performed in the care of women at risk of preterm birth and second trimester foetal loss. While hospital guidelines available online suggest that day case cerclage is possible, we are not aware of any formal national guidelines/recommendations. We report an evaluation following introduction of our day case cervical cerclage pathway via our day surgery unit (DSU), using elective gynaecology lists rather than obstetric theatres, therefore reducing the burden placed on labour ward and obstetric theatres.
Methods: A guideline for day case cervical cerclage was developed, covering the pathway from obstetric surgeon decision to proceed, pre-operative assessment via the elective pre-operative assessment team, perioperative care, and anaesthesia. Data were collected prospectively, including duration of surgery and hospital stay, anaesthetic technique, analgesia requirements and any complications.
Results: Between 15.9.22 and 4.4.23 we have successfully performed 5 day case cervical cerclage procedures via DSU. All patients underwent spinal anaesthesia with 2% Hyperbaric Prilocaine (average dose 2.2ml). Surgical procedure time was between 8 and 20 minutes. All patients were discharged home by 16:30pm. No patients required intra-operative analgesia or conversion to general anaesthesia. One patient had mild pain post-operatively. Urinary retention was an issue for the first two patients, but no further patients since the guideline was subsequently amended to limit intra-operative IV fluid to 500mls.
Conclusions: Our pathway has demonstrated that day case cervical cerclage can be safely performed via DSU using elective gynaecology lists, offering benefits to patients and the hospital.