11 - A pragmatic approach to safe anaesthesia

Summary

Background

An estimated 536 000 women die each year owing to complications arising from pregnancy and childbirth. Eighty percent of maternal deaths are due to haemorrhage, sepsis, eclampsia, obstructed labour and complications of abortion. A larger number of women survive with residual complex physical and emotional health problems as a result of such complications. Neonatal welfare is inextricably dependent on maternal welfare. An estimated 4 million neonatal deaths occur each year, three-quarters of which occur in sub-Saharan Africa and South Asia. Inexpensive and simple medical and surgical interventions are recognised to be life saving in the management of these conditions.

The impact and importance of safe anaesthesia in obstetric care

The optimal management of potentially life-threatening complications of childbirth and pregnancy requires anaesthesia or anaesthetic-related skills. In the UK, anaesthetists are involved in the care of over 50% of women in a typical delivery unit.

The most obvious role of the anaesthetist in the obstetric care of women is in the provision of anaesthesia for caesarean section and epidural analgesia for labour but the role goes far beyond this. Anaesthesia may be required to facilitate surgery to gain control of life-threatening haemorrhage that otherwise could become catastrophic, as in women with uterine atony, ruptured uterus, retained placenta or genital tract trauma. Anaesthesia is needed to manage other life-threatening obstetric conditions such as prolapsed cord, obstructed labour and drainage of a septic focus.