ABSTRACT
Background: Entonox (Nitrous oxide in 50% oxygen) is commonly used for labor analgesia in obstetric units. During the pandemic uncertainties around the risk of aerosol generation and virus transmission led to withholding Entonox for women in labor for a 3-week period at our institution. We aimed to determine if withdrawing Entonox for labor analgesia impacted primarily on epidural rates, opioid analgesia use and several other secondary outcomes. Methods: The audit population included all women laboring during March 9-28 (the Entonox group), and March 29-April 16, 2020 (the COVID group). Women who delivered prior to, or within 30 mins of arriving on the birthing unit;as well as women with an intrauterine foetal death and those with incomplete clinical records were excluded. Binary outcomes were analysed using logistic regression and skewed continuous outcomes were logtransformed and analysed by linear regression. Models were adjusted for maternal and clinical risk factors, such as primiparity and induction of labor. Results: There were 122 and 121 women in the Entonox and COVID groups, respectively. Maternal demographics were similar between the groups (Table 1). Epidural requests were similar. Opioid use was significantly higher when Entonox was not available, but there were no significant differences in any maternal and neonatal outcomes (Table 2). Conclusion: Results from our study suggest that withholding Entonox in labor did not result in higher epidural rates. Opioid analgesia requirements were significantly increased. Withholding Entonox appeared safe and did not impact on any maternal and neonatal outcomes. (Figure Presented).
ABSTRACT
Background: Blood services have been challenged to maintain their inventory during COVID-19. An expert group issued a 'Call to Action' to all stakeholders to implement practical, multimodal principles of Patient Blood Management (PBM). Intraoperative cell salvage (IOCS) is central to PBM also for lower segment cesarean section (LSCS). Prior to April 2020, we initiated IOCS during LSCS based on risk assessment for hemorrhage and patient factors. As the pandemic broadened, we mandated IOCS to reduce blood product usage. We examined the impact of routine IOCS on the incidence and degree of post-partum anemia, transfusion, and other maternal outcomes. Methods: We conducted a single-centre before-and-after study of obstetric patients undergoing LSCS in the 2 months prior to change in practice ('usual care', n=203) and the 2 months following ('mandated IOCS', n=228). Recovered blood was processed when a minimal autologous reinfusion volume of 100 ml was expected. Data were analysed using t-tests for normally distributed continuous data (else Mann Whitney U-tests) and Chi Squared test for frequency data. Post-operative iron infusion and length of stay (log-transformed) were modelled using logistic and linear regression, with inverse probability weighting to account for potential confounders. Results: Maternal demographics were similar between groups. (Table 1). More emergency LSCSs occurred in the usual care group. Compared to the Usual Care group, post-operative Hb was higher, and anemia cases, frequency of IV iron and length of stay were all lower in the Mandated IOCS group (Table 2). After statistical modelling, rates of post-partum iron infusion were significantly lower in the Mandated IOCS group but there was no difference in length of stay. Conclusion: Routine cell salvage provision during LSCS resulted in increased post-partum Hb and reduced anemia prevalence. This translated into a reduction in post-partum iron infusions. IOCS for LCSC may contribute to an avoidance of limited blood service products. (Table Presented) .