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Recommendations made into anaesthetic care to reduce perinatal deaths and brain injuries during childbirth

News 17 July 2018

The Royal College of Obstetricians and Gynaecologists (RCOG) has today published a report into anaesthetic care, as part of its national quality improvement programme into stillbirths, neonatal deaths and brain injuries that occur during childbirth.

Launched in 2014, the Each Baby Counts programme aims to reduce the number of babies who die or are left severely disabled as a result of incidents occurring during term labour by 50% by 2020. In 2017, the College published a landmark report based on the care of 1,136 babies born in the UK in 2015 and found that 76% of these babies might have had a different outcome with different care. It also included recommendations highlighting critical factors in the care of the many of these babies that may prevent these incidents in the future.

Detailed further analysis of the Each Baby Counts data has now been conducted into the anaesthetic care given to the mothers of 49 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 contributor to their outcome, most of the anaesthetic issues noted in these reviews contributed 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 improvement also included the care of women with partially effective regional anaesthesia and failed intubation.

Recommendations

  • 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.
  • All local reviews conducted into adverse neonatal outcomes should, where relevant, 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 degrees 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 function of an in-labour epidural should be taken into consideration when deciding on the most appropriate and timely means of anaesthesia.
  • 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 a 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.

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

ENDS

For media enquiries, please contact the RCOG press office on 020 7045 6773 or email pressoffice@rcog.org.uk

Notes to editors

Read the themed report on anesthetic care (published July 2018)

Read the 2015 full report and press release (published October 2017).

Read the 2015 interim report and press release (published June 2016).

Each Baby Counts is the RCOG’s national quality improvement initiative to reduce by 50% the number of babies who die or are left severely disabled as a result of incidents occurring during term labour by 2020. The project has had a 100% participation rate with UK NHS Hospital Trusts and Health Boards.

The Royal College of Obstetricians and Gynaecologists (RCOG) is a medical charity that champions the provision of high quality women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision. Visit our website www.rcog.org.uk or follow us on Twitter @RCObsGyn