Current status of obstetric anaesthesia: improving satisfaction and safety

Abstract

The Centers for Disease Control and Prevention (CDC) reported in 2003 that although the maternal mortality rate has decreased by 99% since 1900, there has been no further decrease in the last two decades1. A more recent report indicates a rate of 11.8 per 100,000 live births2, although anaesthesia-related maternal mortality and morbidity has considerably decreased over the last few decades. Despite the growing complexity of problems and increasing challenges such as pre-existing maternal disease, obesity, and the increasing age of pregnant mothers, anaesthesia related maternal mortality is extremely rare in the developed world. The current safety has been achieved through changes in training, service, technical advances and multidisciplinary approach to care. The rates of general anaesthesia for cesarean delivery have decreased and neuraxial anaesthetics have become the most commonly used techniques. Neuraxial techniques are largely safe and effective, but potential complications, though rare, can be severe.

Keywords: Combined Spinal Epidural (CSE); Hypotension; Maternal mortality; Obesity; Obstetric Anesthesia; Preeclampsia.

Fig 1

Cause-specific proportionate mortality for 1979-1986 , 1987-1990 and 1991-1997 , in the United States. HDP = hypertensive disorders of pregnancy;CVA = cerebrovascular accident.(Data from Berg CJ, Chang J, Callaghan WM, et al. Pregnancy-related mortality in the United States. 1991-1997. Obstet Gynecol. 2003;101:289-296 with permission).

Fig 2

Preterm birth rates for all births and for singletons only: United States, 1990, 2000, and 2005. (Data From Martin JA, Hamilton BE, Sutton PD, et al. Births: Final data for 2005. Natl Vital Stat Rep 2007; 56:1-103.)