SAFER DELIVERIES: Dr Sng Ban Leong simulating the application of the DIVA System in an operating theatre.
THE DIVA (Double Intravenous Vasopressor Automated) system was developed by doctors at KK Women’s and Children’s Hospital (KKH) to manage the blood pressure of patients during a caesarean section under spinal anaesthesia. It automatically administers required amounts of medication to normalise blood pressure and heart rate when they drop.
The system has not yet been implemented in patient care, but has been tested successfully. A 2011 study, jointly carried out by KKH and Duke-NUS Graduate Medical School and involving 55 women, showed that it was more effective than conventional methods at maintaining blood pressure during caesarean section that involves spinal anaesthesia.
Professor Alex Sia, Chairman, Medical Board, KKH, and Dr Sng Ban Leong, Consultant, Department of Women’s Anaesthesia, KKH, led the study.
The DIVA system provides an important safety enhancement for patients. “It is a novel invention, enabling very close monitoring and rapid response to better manage patients’ blood pressure during caesarean delivery. This new research development reinforces patient safety and boosts clinical outcomes,” said Prof Sia, who is also a Senior Consultant at the Department of Women’s Anaesthesia, KKH.
Low blood pressure during a caesarean delivery can harm both mother and baby. Up to 60 per cent of women experience it during a caesarean section where spinal anaesthesia is administered. This may cause them to feel nauseous during delivery and in more severe cases, reduce blood flow to the placenta, causing harm to the baby.
At KKH, where 30 to 35 babies are delivered a day, about a third are caesarean births. Currently, an anaesthetist monitors a patient’s blood pressure, and when it falls, manually administers vasopressors – medication that raises blood pressure by constricting blood vessels. This method is both labour-intensive and limited by the monitoring equipment, which gives readings at one-minute intervals, potentially delaying response time.
The DIVA system, on the other hand, is much quicker. Blood pressure and heart rate data are measured and recorded every second, and sent to a computer from two finger cuffs worn by the patient. An advanced programme then calculates the dosage of vasopressor required and automatically administers it to the patient through a syringe pump.
Besides safer deliveries, the DIVA system also has other benefits.
Dr Sng said: “The automated system allows anaesthetists to focus on other important aspects of holistic patient care, including establishing better communication and rapport with the patients and their partners. This further enhances a patient’s comfort and experience during a caesarean delivery.”
• This story was first published in Singapore Health, Nov/Dec 2013.