Obstetric anaesthetic deaths in context.

PURPOSE OF REVIEW: Although there have been few recent publications about obstetric deaths due to anaesthesia, it is timely to review their occurrence and put them into context. Health services are under constant review and a recent Department of Health publication highlights the need for safer care. Changes, including those related to training and permitted hours of work, may impact on safety. Without knowing where we are now, we cannot know whether these changes are an improvement or not. RECENT FINDINGS: The UK Confidential Enquiry reports have tracked anaesthetic-related deaths since 1952. During the 1990 s, the numbers became almost irreducible: the last report gave six deaths caused by anaesthesia. This review puts these into a global perspective. SUMMARY: Medical intervention undoubtedly saves many lives. Concerns about a possible increase in anaesthetic maternal mortality must be kept in perspective with the overall benefits. The growing complexity of problems such as maternal disease, obesity, and the increasing age of motherhood, nevertheless, increases the challenges presented. Multidisciplinary working is all-important.

The challenges of obesity and obstetric anaesthesia.

PURPOSE OF REVIEW: The aim of this article is to review the clinical challenges of obesity in obstetrics from the anaesthetist's viewpoint. RECENT FINDINGS: The prevalence of obesity continues to increase both in the community and on the labour ward. Women who have undergone bariatric surgery are also on rise. During pregnancy, obesity is associated with hypertensive disease (chronic hypertension and preeclampsia), diabetes mellitus (pregestational and gestational), respiratory disorders (asthma and sleep apnoea), thromboembolic disease, caesarean section and infections (primarily urinary tract infections, wound infections and endometritis). Obesity is a risk factor for anaesthesia-related maternal mortality. Obese women are not only at high-risk of airway complications, cardiopulmonary dysfunction, perioperative morbidity and mortality but also pose technical challenges. Obesity also influences the fetal outcomes. Increasing use of regional techniques contributes to the reduced anaesthesia-related maternal mortality. Preconception counselling, antenatal screening and anaesthetic assessment are strongly encouraged. SUMMARY: Effective communication and good teamwork between an anaesthetist and an obstetrician are essential for the care of obese parturients. A more liberalized use of regional techniques may be a means of further reducing the anaesthesia-related maternal mortality.