Objectives To investigate time in theatre recovery for women who received carbetocin at Caesarean Section (CS) compared with a historical cohort. To compare costs per patient, from a health sector perspective, between the two cohorts. Methods We evaluated outcomes for all women (elective and emergency) undergoing CS, after the introduction of carbetocin in April 2012. The controls comprised every 3rd patient undergoing CS in January 2012 (pre-carbetocin). Main outcome measure Difference in time in theatre recovery between the two groups. Results Women who received carbetocin (n = 265) spent less time in recovery than the historical cohort (n = 33) (carbetocin 170 min, syntocinon 271 min; difference: –101.3023 minutes, 95% CI: –175.8518; –26.75276, p < 0.01). Additionally there was reduced need for additional 3rd stage uterotonics (carbetocin 16%, syntocinon 60%; mean difference in proportion: –0.294, 95% CI: –0.1183; –0.4697). This is consistent with findings from RCTs. Using financial modelling (Abstract No: PL.19) drug cost per patient when all 3rd stage requirements are included is carbetocin £7.78 v syntocinon £6.37. In addition, reduced theatre recovery time has potential midwifery staffing cost efficiencies of up to £189,000 pa. Conclusion Carbetocin decreases time spent in recovery post-CS, and reduces the need for additional 3rd stage management. Discussion Introducing carbetocin routinely for all CS will reduce recovery times and potentially constitutes a cost saving. There are likely to be additional important staffing and theatre efficiencies.

AbstractsMethods 163 maternity units were surveyed online in Sept/Oct 2011, and again in Sept/Oct 2012. In 2012, non-responders were followed up by telephone contact. The overall response rate improved from 32.5% (54 units) in 2011 to 73% (119 units) in 2012. Data were analysed quantitatively using contingency tables, and spatially using Geomapping software. Results In 2012, 87% (CI; 80-92%) of units used biochemical testing to predict PTL, a significant (p < 0.05) increase from 2011 (76%, CI; 63-85%). For units where data were available for both years, 33% altered their method of PTL testing between 2011-2012, with 40% of these initiating biochemical testing. 14 units did not test for pre-term labour (11%, CI; 7-18%). The most commonly cited barriers to testing were cost and inexperience of operators, each cited by 16% of units (CI; 10-24%). On the basis of test results, 94% (C1; 87-97) of units gave steroids, but only 77% (CI; 67-84) discharged home and 82% (CI; 73-88%) arranged in utero transfer. Conclusions Our results suggest a heterogeneous pattern of test utilisation. The high proportion of units changing methods within a year implies confusion regarding optimal strategies for PTL prediction. There is an urgent need for further research and clearer guidance in this area. Heterogeneity in protocols could lead to suboptimal allocation of valuable neonatal network resources. Validation of a Skill liSt of non-technical

To fulfil both risk management and CNST, we audit all haemorrhage >2000ml identified through EuroKing, against our departmental guideline, in a monthly multidisciplinary risk meeting (including laboratory staff). A modified data collection tool from SCASMM is used. Comparison is made with the most recent (2009) annual Scottish audit of haemorrhage >2500ml. Conclusions Data is broadly comparable with a recognised national audit. Our process provides a robust method for continuous audit of haemorrhage. Introduction of a proforma (Nov 2010), presentation at departmental meetings (6 month intervals) and improved awareness/accountability has achieved improvements including: Increased obstetric consultant presence; Improved documentation; Reduced blood in major haemorrhage pack from 6 to 4 units (>4 units only used in 9.7%). Abstract PL.31 Table Southmead Nov –Oct 11 SCASMM (2009) Number >2000ml 62 N/A >2500ml 28 (4.61 per 1000) 306 (5.18 per 1000) Most frequent causes (60 notes fully reviewed) Atony (33) 55% 54.5% Retained placenta (13) 21.7% 19.4% Vaginal laceration (11) 18.3% 20.1% Most frequent mode of delivery SVD (20) 33% 30% Emergency caesarean (19) 31.6% 41.4% Elective caesarean (8) 13.3% 9.8% Haemostatic surgical techniques Intrauterine balloon (6) 10% 19% B-Lynch suture (5) 8.3% 9% Ut. artery embolisation (1) 2% 3% Hysterectomy (1) 2% 8% Nov10-Apr11 May11–Nov11 Consultant obstetrician present >2000ml 72% 84% N/A >2500ml 93% 100% 73% Proforma used 65% 80%

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Introduction Rising caesarean rates may increase incidence of abnormal placentation. Appropriate multidisciplinary management is needed. We report the first documented case of successful outcome of placenta percreta with twins. Case report A 40 year old P4 (all caesarean sections) with dichorionic-diamniotic twins had an anterior low placenta at anomaly scan. Following an antepartum haemorrhage at 30+1weeks, hospital admission with subsequent investigations revealed intermittent haematuria. An inconclusive MRI was compared with a greyscale ultrasound scan, resulting in a provisional diagnosis of placenta percreta, involving the posterior bladder wall. A proforma was designed to arrange a large multiprofessional team for delivery. Contractions at 34+1weeks prompted emergency delivery. Utilising the proforma to coordinate primed teams meant interventional radiology followed by caesarean with general anaesthetic ensued. Both twins were born in good condition, requiring a short SCBU admission. The upper placenta separated easily. The lower placenta was morbidly adherent, extending through the uterus into the right broad ligament. It approximated the bladder surface but did not breach the muscle. Management necessitated hysterectomy; difficult identification of tissue plains resulted in a cystotomy, which urologists repaired. Blood loss was 3000ml; transfusion with autologous blood was achieved. Discussion Management of this case of twins with placenta percreta using reusable management template, which was designed assisted by RCOG Guidelines, resulted in successful pregnancy outcome. This is first report of successful outcome of twins with abnormal placentation; previous cases have discussed early uterine rupture. Conservative options were discussed as alternative management for the adherent placenta.