THE PRACTICE OF OBSTETRICAL ANALGESIA AND ANESTHESIA IN FRANCE - A NATIONWIDE SURVEY

Objective: To assess the rate of epidural analgesia (EA) for parturiti on and the techniques of anaesthesia for Caesarean section (CS). Study design: Retrospective study. Patients: A series of 84,235 deliveries. Methods: The series was extracted from a total of 770,054 deliveries carried out in 1991, according to the number of births in each hospita l (1/1 if the births were less than or equal to 100 per year, up to 1/ 25 if they were greater than or equal to 2,000 per year). The data ana lyzed included: anaesthesia technique, whether or not there was an ana esthetist on night duty at the hospital, birth rate in the hospital, t ype of hospital: university (UH), general (GH) or private (PH). For va ginal deliveries, the mode of labour commencement (spontaneous or indu ced), the multiplicity of pregnancies and a history of past CS were al so noted. Results: Vaginal deliveries: the overall rate of EA was 37.2 %. EA were not carried out in 5% of maternity hospitals. In cases of s pontaneous labour, the average rate was 32.1%, significantly less than for induced labour (59.6%, P < 0.0001) and in cases of previous CS (3 9%, P < 0.05). There was no statistical difference in cases of multipl e pregnancies (35.7%). The average rate of EA was correlated to the nu mber of annual births (P < 0.001) and was increased when the anaesthet ist was present in hospital at night (P < 0.001). It was also signific antly lower in GH (P < 0.001) than in UH or PH, which were equivalent Scheduled CS: general anaesthesia (GA) was carried out at a significan tly higher rate than regional anaesthesia (RA) (49.7% vs 48.4%, P < 0. 05). In 15.1% of hospitals, RA was not available. The incidence of RA was influenced neither by the rate of annual births nor by the presenc e of the anaesthetist in the hospital during night. However, RA was si gnificantly less frequent in GH (46.3%, P < 0.001) than in UH (48.6%) and in PH (53.6%) which were equivalent. CS during labour: the inciden ce of RA was significantly higher than GA (53.2% vs 44.1%, P < 0.001). In 17.1% of hospitals, RA was never carried out. The rate of RA was c orrelated to the size of the maternity hospital, and significantly hig her (P < 0.001) when the anaesthetist was present in hospital during n ight. The differences between UH, GH and EP were the same than for sch eduled CS. Conclusion: In France in 1991, the average rate of 37.2% fo r EA for obstetrics was high when compared to the rate in United Kingd om. It was equivalent to those in United States and Ontario, Canada. T he discrepancies between hospitals were mainly related to structural a nd organizational factors. The influence of the size of the maternity hospital, the 24-hour service of EA was also shown in other studies. H owever, the difference between GA and UH and PH is a French particular ity. The high rate of GA for CS differs largely with those in the UK o r the USA. The time saving aspect of GA was probably an important fact or for the choice of this technique. This study must be reactualized a nd enlarged to determine the demand of EA for labour by parturients an d obstetricians. (C) 1998 Elsevier, Paris.