During central neuraxial blockade, identifying the midline in parturients can be difficult, particularly if they are obese. We assessed the ability of women in late pregnancy, both obese and non-obese, to identify the midline of their own back by pointing and by pinprick discrimination with reference to the true midline identified by ultrasound. Thirteen out of 25 (52%) obese women were accurate to within 5 mm in identifying the midline of their back by pointing with their fingertip, compared with 21/25 (84%) non-obese women (p = 0.03). The median (IQR [range]) fingertip-midline distance was greater in obese women (5 (5-10 [0-10]) mm compared with non-obese women (2 (0-5 [0-12]) mm; p = 0.007). Identification of the midline using pinprick was poorer by obese women (median (IQR [range]) 33 (25-45 [3-85]) mm) than by non-obese women (18 (13-25 [8-40]) mm; p < 0.0001). However, women in both groups were correct > 99% of the time in identifying that a stimulus was either to the left or to the right side.

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Since the Term breech trial, elective caesarean section (CS) rather than vaginal delivery has become standard practice for breech presentation. External cephalic version (ECV), manual rotation of the fetus from a breech to a cephalic position, is an alternative to a CS1 and is recommended by the Royal College of Obstetricians and Gynaecologists. Anxieties about procedural pain and concerns of risks to the fetus are major reasons women decline ECV.2,3 In 2011, 3.8% (n = 190) of babies were breech in our hospital and only 16.3% (n = 31) of these women opted for ECV after seeing various health professionals. Different obstetricians had an overall success rate of 25.8% performing ECV. A dedicated breech service led by a specialist midwife and an obstetrician was developed in 2013 (Figure 1). Over the subsequent six-months, 83 women were referred to the service. Sixty women were confirmed breech at their first visit and 50 persisted as breech at their second visit. Thirty-nine women (78%) agreed to an ECV performed between 36 and 37 weeks and the ECV success rate improved to 48.6% (p < 0.05 vs pre-service using Chi-square test). Reasons for the improved uptake and success of ECV include better communication, the offer of analgesia (remifentanil) and a single operator. 83.3% of the women who had a successful ECV subsequently achieved a vaginal delivery. Abstract PA.12 Figure 1 Breech pathway References Sullivan EA, Moran K, Chapman M. Term breech singletons and caesarean section: a population study, Australia 1991-2005. Aust N Z J Obstet Gynaecol 2009;49:456–60 Rosman AN, Vlemmix F, Fleuren MAH, et al. Patients’ and professionals’ barriers and facilitators to external cephalic version for breech presentation at term, a qualitative analysis in the Netherlands. Midwifery May 13 2013; doi: 10.1016/j.midw.2013.03.013 Vlemmix F, Kuitert M, Bais J, et al. Patient’s willingness to opt for external cephalic version. J Psychosom Obstet Gynaecol 2013;34:15–21

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