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Themed report on anaesthetic care

Recommendations to reduce perinatal deaths and brain injuries during childbirth

As part of the Each Baby Counts programme, a further detailed analysis of the data has been conducted into the anaesthetic care given to the mothers of those babies reported to Each Baby Counts between 2015 and 2017.

This special report – supported by the Royal College of Anaesthetists and Obstetric Anaesthetists Association – will form part of a wider set of findings and recommendations from the Each Baby Counts programme, to be published in autumn 2018.

Key findings include:

  • Many of the lessons on 'human factors', identified in the Each Baby Counts 2015 full report, are echoed in this latest report
  • Although there were no babies for whom anaesthetic problems were thought to be the sole contributory factor to their outcome, most of the anaesthetic issues noted in these reviews contributed additionally to delays in delivery
  • There is a clear need to optimise communication about the urgency of delivery to allow for informed choice of method of anaesthesia.
  • Key themes for improvements also included the care of women with partially effective regional anaesthesia and failed intubation.

 

Key recommendations

All reviews should involve an obstetric anaesthetist and should include review of the detailed anaesthetic record.

Anaesthetists should always be informed of the degree of urgency of delivery. As an aid to communication, the classification of urgency of caesarean section should be used for all operative deliveries, vaginal as well as abdominal.

A decision about the purpose of transfer to theatre and urgency of any delivery should be made together with the anaesthetist before transfer to theatre. The degree of urgency should be reviewed on entering theatre prior to the WHO check, and the obstetrician should confirm the degree of urgency directly to the anaesthetist.

Anaesthetists should use a structured and validated anaesthetic handover tool between shifts and, if possible, participate in the routine labour ward handover/review of the delivery suite board. This will help maintain situational awareness and enable early anticipation of anaesthetic difficulties.

All women who receive epidural analgesia should be reviewed to ensure the effectiveness of the epidural and to minimise delays should the need for operative delivery arise. The functioning of an in-labour epidural should be taken into consideration when deciding on the most appropriate and timely means of anaesthesia for operative delivery.

The safety of the mother must be the primary concern at all times. Women should not be put at risk of airway problems through inadequate preparation/positioning due to haste to achieve rapid delivery. The required equipment for the management of difficult and failed tracheal intubation in obstetrics detailed in the OAA/DAS guidelines should always be available and all anaesthetists should undergo specific difficult airway training.

There is a need for the development of a structured communication tool to include the three-fold elements of the delivery plan: mode of delivery, location of birth and category of urgency. This will form a key Each Baby Counts implementation output from this report, and the RCOG is committed to collaborating with the relevant organisations to produce this at the earliest opportunity.

 

The RCOG welcomes the support of the Obstetric Anaesthetists’ Association (OAA) and Royal College of Anaesthetists (RCoA) in the publication of this report.