Blood tests required before labour neuraxial block: A midwife-focused service intervention

Published Date: 15th August 2018

Publication Authors: Gerrard C

Introduction

There is no guidance in the UK on what blood tests are required before neuraxial block, or their timing. In labouring women, the decision regarding the safety of spinal and epidural block is left to each individual anaesthetist. This leads to delays in delivery of epidural analgesia and results in unnecessary general anaesthesia (GA) for caesarean section. This study was prompted by two such cases in our department. As there is no clear consensus on which tests are required and when, it is unsurprising when a desired blood test has been omitted. The aim of this study was to assess current knowledge on blood tests required before neuraxial block and then introduce local guidance. 

Methods

Initially a departmental survey of 30 midwives was performed. This examined the understanding of midwives as to which blood tests were required and their timings in six clinical scenarios. This was followed by the development of locally agreed guidelines. This was distributed to the obstetric department along with an education programme and ready availability of these guidelines in each labour room. Midwives were subsequently re-surveyed in order to ascertain if there had been any change in findings. 

Results

Thirty midwives responded each to the pre-and post-survey. 

Discussion

This study emphasises the importance of local guidelines which detail the required tests, and when they should be done, before performing a labour neuraxial block. A recent survey suggests only 60% of departments have such guidelines.1 It is also demonstrated that strategies to reduce unnecessary GA sections and delays in epidural analgesia should be multi-disciplinary as it is often midwives who request the required tests. Our intervention aimed to develop midwives' knowledge of the tests and also improve the system by creating easily accessible guidelines in strategic locations throughout the obstetric department. This approach resulted in much improved understanding of the tests required and gave midwives the guidance to make informed decisions about what tests are required for their patients. It is anticipated that this will lead to timely and safe interventions for our patients.

 

Muler, TR; Gerrard, C; Rodgers, KG. (2018). Blood tests required before labour neuraxial block: A midwife-focused service intervention. International Journal of Obstetric Anesthesia. 35 (Suppl 1)

« Back