THE OBSTETRICAL-ANESTHESIA ASSESSMENT CLINIC - A REVIEW OF 6 YEARS EXPERIENCE

We reviewed the out-patient consultation notes of 136 pregnant women s een at the Ottawa Civic Hospital from 1985 to 1991 to evaluate the eff iciacy of an Obstetric Anaesthesia Assessment Clinic (OAC). In additio n, their anaesthetic records from labour and delivery were reviewed. F or each patient the reason for referral was recorded according to the involved organ system. The anaesthetic management at delivery was comp ared with the proposed anaesthetic plan by the OAC consultant (obstetr ic anaesthetist). The majority of women 84 (62%) had complaints relate d to the musculo-skeletal system. In addition, 18 patients were referr ed because of previous anaesthetic problems, ten with a history of car diac disease, and eight with neurological disease. Lumbar epidural ana lgesia (LEA) was a safe and effective choice for parturients with low back pain, history of lumbar fractures or single level discectomies wi thout lumbar fusion. Parturients with posterior instrumentation experi enced an increased incidence of inadequate pain relief from LEA. Indiv idualized anaesthetic management plans were executed for parturients w ith spina bifida occulta, neurological, cardiac, and haematological di sease as well as for women with a history of adverse drug reactions an d previous problems with regional or general anaesthesia. It is conclu ded that the OAC has provided a valuable service to obstetricians and anaesthetists for the anaesthetic management of pregnant women with co existing disease. The OAC gave an opportunity for patient education re garding anaesthetic options for labour and delivery. The attending ana esthetist was provided with a risk assessment and anaesthetic manageme nt plan which was adhered to with only two exceptions. Finally, the ob stetrician was given consistent advice regarding anaesthesia managemen t that may affect obstetrical decisions.