Study evaluates Variability in obstetric anaesthesia practice and care

It is crucial to provide excellent hospital care during labor and delivery to decrease avoidable maternal morbidity and mortality. The latest MBRRACE-UK report found that while deaths directly linked to anesthesia are uncommon, enhancing the overall peripartum care provided to 38% of those who passed away between 2018 and 2020 could have impacted the outcome, as only 22% received high-quality care. Recent study examined the variability in obstetric anesthesia practice and care within the UK's National Health Service. The researchers conducted a survey of 106 out of 107 participating hospitals, representing 69% of all UK obstetric units. The key findings were: Staffing and Training: - 94% of hospitals had a dedicated consultant obstetric anesthetist during working hours, but 25% of out-of-hours duty anesthetists had other clinical commitments outside of obstetrics. - 98% of hospitals offered multidisciplinary team training, mostly using simulation-based methods. Facilities and Resources: - 47% of hospitals had dedicated high-risk antenatal clinics, and 77% provided written patient information on anesthesia options in multiple languages. - 69% used point-of-care testing to estimate hemoglobin concentration. Clinical Practices: - 76% used patient-controlled epidural analgesia during labor, and 26% used programmed intermittent epidural boluses. - 93% used intrathecal diamorphine for elective cesarean deliveries, with a common dose of 300 mcg. - 74.5% routinely used intraoperative patient warming measures. Outcomes and Quality Indicators: - 76% tracked the incidence of post-dural puncture headache, with a median incidence of 0.96%. - 75% and 67% recorded elective and emergency cesarean delivery rates, respectively, but only 13% measured achievement of adequate pain relief 45 minutes after epidural placement

The study demonstrates significant variability in staffing, facilities, clinical practices, and outcome measurements related to obstetric anesthesia across the UK. The authors recommend standardizing anesthetic peripartum care based on national guidelines and systematically measuring quality indicators to ensure safe and equitable care.

Key Points

1. 94% of hospitals had a dedicated consultant obstetric anesthetist during working hours, but 25% of out-of-hours duty anesthetists had other clinical commitments outside of obstetrics.

2. 98% of hospitals offered multidisciplinary team training, mostly using simulation-based methods.

3. 47% of hospitals had dedicated high-risk antenatal clinics, and 77% provided written patient information on anesthesia options in multiple languages. 69% used point-of-care testing to estimate hemoglobin concentration.

4. 76% used patient-controlled epidural analgesia during labor, and 26% used programmed intermittent epidural boluses. 93% used intrathecal diamorphine for elective cesarean deliveries, with a common dose of 300 mcg. 74.5% routinely used intraoperative patient warming measures.

5. 76% tracked the incidence of post-dural puncture headache, with a median incidence of 0.96%. 75% and 67% recorded elective and emergency cesarean delivery rates, respectively, but only 13% measured achievement of adequate pain relief 45 minutes after epidural placement.

6. The study demonstrates significant variability in staffing, facilities, clinical practices, and outcome measurements related to obstetric anesthesia across the UK. The authors recommend standardizing anesthetic peripartum care based on national guidelines and systematically measuring quality indicators to ensure safe and equitable care.

Reference - 

O'Carroll J, Zucco L, Warwick E, et al. (October 04, 2024) A Survey of Obstetric Anaesthesia Services and Practices in the United Kingdom. Cureus 16(10): e70851. DOI 10.7759/cureus.70851