Intrauterine fetal resuscitation and the role of the anaesthetist

Introduction

Fetal distress refers to progressive fetal asphyxia,

which can lead to permanent neurological damage or

death (1). When fetal distress is detected, conservative

interventions can be considered to reduce fetal

hypoxia. While these measures are typically

associated with obstetricians and midwives,

anaesthetists also play an important role. Early

intervention may improve fetal condition, potentially

avoiding operative delivery or allowing for alternative

anaesthetic techniques. This project aims to explore

anaesthetic trainees’ responses to fetal distress and

develop a practical learning tool to guide anaesthetists

in remembering key interventions for intrauterine

resuscitation.

Methods

Anaesthetic trainees were surveyed on their responses

to fetal distress in theatre. The voluntary survey

included questions on the frequency of intervention

and the specific actions taken. A literature review was

conducted to assess guidelines on intrauterine

resuscitation and evaluate existing aide-memoires,

which informed the creation of a focused aide-memoire

for obstetric anaesthetists.

Results

Six anaesthetic trainees responded to the voluntary survey.

66.7%reported taking measures only sometimes to improve

fetal distress. The most commonly described interventions

were changing maternal position and improving blood

pressure. Thurlow & Kinsella proposed the SPOILT

mnemonic for intrauterine fetal resuscitation, which stands

for: Syntocinon off; Position the mother; Oxygen; IV Fluid;

Low BP; and Tocolysis. (1) Although these measures remain

relevant, recent NICE guidelines emphasise conservative

management tailored to the cause of distress and notably,

state that oxygen should only begiven if the mother is

hypoxic. (2) Based on this updated guidance, we developed

a mnemonic: "Fetal distress? Give the baby a REST." REST

stands for: Reposition mother; Evaluate observations; Stop

Syntocinon; Think about tocolysis. This mnemonic is

designed to prompt immediate, actionable responses,

focusing on dynamically assessing maternal indicators and

treating as appropriate.

Conclusion

This project highlights the need for an updated, memorable

mnemonic to guide anaesthetists in managing fetal distress.

The "REST” mnemonic, informed by recent guidelines,

provides anaesthetists with a simple tool to improve patient

care. Future research could assess anaesthetists’

perspectives on this learning aid and sharing it with the wider

perinatal team may enhance collaborative care.