Obstetric Anesthesia Care

Obstetric Anesthesia care

A significant number of women require advice and care from anaesthetists before, during or after childbirth. The requirement is often urgent and may occur at any time.

Obstetric Anaesthesia is providing safe skilled analgesia and anesthesia for pregnant patients. This includes:

1. Epidural analgesia for labour.
2. Anaesthesia for operative procedures

Obstetric Unit provides 24-hour service for the analgesic, anaesthetic and resuscitation requirements of women admitted to the hospitals with conditions associated with childbirth. Whenever available a named consultant should have responsibility for the organization and management of the service. Specialist has to be assessed as competent by a consultant anaesthetist with responsibility for obstetric anaesthetic services before undertaking obstetric anaesthesia care.

Mothers may require specialist consultation, assessment and advice. Anaesthetists are responsible for analgesia, anaesthesia, resuscitation and intensive care. An on call anaesthetist, is available for the provision of anaesthesia for an instrumental oroperative procedure.

1. Where an epidural analgesic service is provided an anaesthetist of adequate experience should be immediately available to the obstetric service throughout the 24 hours.
2. And in case of high risk cases will inform the anaesthesia consultant on call.

The on call anaesthesia consultant will cover the obstetric unit when the on call specialist is busy. Pre and post procedure visiting of patients for assessment and explanation, early detection of complications. Written notes and records of all visits and clinical procedures undertaken should be documented.

Support Services

• Hematology (including coagulation studies) and biochemistry services must be available to provide rapid analysis of blood and other body fluids and to make available blood and blood products for transfusion without delay and in sufficient quantities. A supply of uncross matched 0 Rh. negative blood or screened and group-confirmed blood must always be available for emergency use. Rapid efficient communication channels must exist to avoid delay in the event of massive hemorrhage.
• There must be provision for rapid availability of consultation with other specialists experienced in non-obstetric aspects of pregnancy such as cardiac disease and diabetes.
• Imaging services are available if needed.

Premises

1. A dedicated operating theatre must be available at all times for obstetric anaesthesia.
2. An appropriately equipped post anaesthetic Recovery room of adequate size and staffing for the work of the unit must be available within or close to the labour ward.
3. Emergency resuscitation equipment and a cardiac arrest procedure must exist for obstetric patients and be known to all staff.

Intensive Care

Maternity unit must have access to an appropriately staffed ICU for transfer of patients, either pre- or post- delivery as required. That whilst in the ICU, patients will continue to receive obstetric care from the obstetric team involved.

Training and Education

1. Whenever available consultant anaesthetist should be nominated in charge of training in obstetric anaesthesia and analgesia.
2. Guidelines for the management of obstetric and anaesthetic complications such as failed intubation, major hemorrhage, inhalation of gastric contents, anaphylaxis and post spinal Epidural puncture headache must be established and rehearsed.
3. There must be clear written guidelines for the emergency resuscitation of pregnant women, oral intake during labour and management of such conditions as pre-eclampsia and diabetes.

Patient Information

1. Women must have the opportunity to make informed choices about pregnancy, delivery, analgesia and anaesthetic interventions. Access to an anaesthetist in the antenatal and postnatal period is available.
2. Whenever an anaesthetic or analgesic intervention is to be undertaken, the woman must be given appropriate relevant information in terms that she can understand. Any questions must be answered and consent obtained for any intervention.