Expectant mothers concerned about receiving an epidural, spinal or general anaesthesia during childbirth can breathe a little easier. According to a study published in the June issue of the journal Anesthesiology, serious complications due to anaesthesia during childbirth are very rare, occurring in 1 out of every 3,000 deliveries.
“This is the first multicentre study to examine the incidence of serious complications associated with obstetric anaesthesia,” said lead author Robert D’Angelo, MD, Wake Forest University School of Medicine, Winston-Salem, North Carolina. “We were extremely pleased to find that serious complications such as bleeding, infection, paralysis, and maternal death were extremely rare. However, since many complications can lead to catastrophic outcomes, it is important that physician anaesthesiologists remain vigilant and prepared to rapidly diagnose and treat any complication, should it arise.”
Using data from the Society for Obstetric Anesthesia and Perinatology’s (SOAP’s) Serious Complication Repository (SCORE) project — a large, comprehensive database that systematically captures delivery statistics and tracks complications — the authors identified more than 257,000 deliveries (including both vaginal and caesarean) where epidural, spinal or general anaesthesia was administered during childbirth. Thirty institutions participated in the 5-year study between 2004 and 2009.
There were 157 total complications reported, 85 of which were anaesthesia-related. Although complications were rare, the most frequent anaesthesia-related complications were high neuraxial block (1 in 4,336 deliveries); respiratory arrest in labour and delivery (1 in 10,042); and unrecognised spinal catheter (1 in 15,435).
In an effort to reduce the incidence of complications and improve patient safety, a secondary goal of the study was to identify risk factors associated with each complication to produce formal practice advisories or guideline recommendations. However, because serious complications related to obstetric anaesthesia are so rare, there were too few complications in each category to identify risk factors associated with each complication. Still, the authors noted that the findings from the study can be used to guide informed consent discussions with patients.
Findings from the study will also be used to establish a national obstetric anaesthesia complication registry as part of the Anesthesia Incident Reporting System developed by ASA’s Anesthesia Quality Institute (AQI) in collaboration with the leaders of SOAP. Unique adverse events captured by this system will be used to generate new alerts to anaesthesiologists and new educational materials to advance patient safety.
SOURCE: American Society of Anesthesiologists
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