Introduction This study was conducted within the tertiary Fetal Medicine Unit (FMU) at St Michael's Hospital (StMH), Bristol. The first aim was to provide improved information regarding neonatal outcomes for parents of pregnancies affected by Haemolytic Disease of the Fetus and Newborn (HDFN) and managed by intrauterine transfusion (IUT). The second aim was to determine if a change in IUT protocol in 2004 had improved safety; including attendance of two FMU Consultants, use of fetal sedation, and use of the intrahepatic vein as an alternative route to placental cord insertion if deemed safer. Methods Data for pregnancies affected by HDFN as a result of haemolytic red cell alloimmunisation and managed with IUT at StMH between 1999 and 2009 were retrospectively collected using local databases, and review of the medical notes. Results 256 relevant IUTs were performed. The median number of IUTs per pregnancy was two. 91% of live deliveries had five minute APGAR scores ≥9. 98% were admitted to NICU/SCBU; requiring phototherapy (96%), exchange transfusion (36%) and top-up transfusion (30% immediate, 13% late). Following the change in protocol, there was a significant reduction in the number of emergency caesarean sections occurring directly after an IUT procedure (n=5vs0;p=0.02). 1% of IUTs resulted in fetal loss within 48 hours of IUT, none of which occurred under the new protocol (n=3vs0;p=0.08NS). Conclusions Although the majority of neonates required admission to NICU/SCBU and phototherapy, the median-term outcomes were positive. Importantly, the safety of the IUT procedure has significantly improved since the change in protocol.

Introduction As obstetricians, we are in danger of losing touch with our patients as they transition out of our care. The Fetal Medicine Unit (FMU) at University Hospitals Coventry and Warwickshire manage many at-risk pregnancies each year, and effective communication with the neonatology department ensures best care at delivery. However, there has been no system in place for regular review of patient outcomes. We proposed to develop a database, available to both departments, providing key information regarding events pre- and post-delivery, in order to improve quality of care through enablement of efficient audit and service evaluation. Methods As a pilot, we collected data on pregnancies managed by the FMU between January and September 2012. Pregnancies were categorised according to reason for initial FMU referral. Obstetric data was collected from the Viewpoint database; neonatal from medical notes. We worked with the IT department to create a shared work space on the hospital intranet, which was then accessed for audit. Results We identified 92 relevant pregnancies. The majority of FMU referrals were for increased Combined Risk Ratios (14%) or Gastrointestinal Tract abnormalities (14/%). Two service evaluations have already been completed using data from the database, and we have received positive feedback from both departments. Conclusions The database successfully provides a platform from which regular audits and service evaluations can be made between the FMU and neonatology department. We plan to maintain this database, allowing us to provide parents with updated local neonatal outcomes, and to better enable clinicians to review and reflect.