///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

Obstetric Anesthesia and Neurological Consultations During Pregnancy

Abstract Number: 104
Abstract Type: Original Research

Michaela K Farber MD, MS1 ; Autumn M Klein MD, PhD2; Dirk J Varelmann MD3; Jean M Carabuena MD4; William R Camann MD5

Introduction: Anesthesiologists and neurologists often encounter patients with neurological problems during pregnancy. A recent analysis of obstetric anesthesia closed claims showed that the most common reason for litigation today among obstetric anesthesia claims is related to peripheral nerve injuries(1). Moreover, this analysis recommends more frequent involvement of appropriate consultants when neurological issues present during and after pregnancy. To optimize the management of neurological disease during pregnancy, a clinical and research collaboration has been formed between the division of Obstetric Anesthesia and the Program in Womens Neurology at our hospital, a large university-affiliated academic medical center. The Program in Womens Neurology is the first of its kind to focus on sex differences in the medical evaluation, diagnosis, and treatment of neurological disease- in particular in the peripartum period.

Methods: After IRB approval, and in collaboration with a neurologist who specializes in neurological disorders in pregnancy, a retrospective analysis of medical records from the Womens Neurology Clinic between January 2006 and January 2009 was performed. Data collected included maternal age, gestational age, gravidity and parity, neurological chief complaint, neurological management, anesthesia care, and anesthesia complications requiring neurology follow-up.

Results: 92 charts have been reviewed: 58% (n = 53/92) of women were seen for headache, most commonly migraine headache, 32% (n = 29/92) for seizure disorder, and 10% (n = 9/92) for peripheral neuropathy. The majority of patients were seen either during their pregnancy (63%) or postpartum (28%), with only 9% presenting before pregnancy. 92% of the women who are now postpartum received neuraxial analgesia or anesthesia. Despite the common use of neuraxial techniques, the incidence of direct anesthetic related complications was rare: there were 2 cases of possible post-dural puncture headache and no identified cases of anesthesia-related neuropathy.

Discussion: Anesthesiologists frequently evaluate patients with neurological injury or headache associated with labor and delivery (2). Obstetrics carries high medical liability risk, with an increasing proportion of claims related to maternal nerve injury. Timely and appropriate referrals to a neurology clinic and close collaboration between obstetric anesthesiologists and neurologists could help to improve patient outcome, counseling, and satisfaction.

References

1. Davies JM, Posner KM, Lee LA, Cheney FW, Domino KB. Liability associated with obstetric anesthesia. A closed claims analysis. Anesthesiology 2009; 110:131-9.

2. Birnbach DJ, Ranasinghe JS. Anesthesia complications in the birthplace: is the neuraxial block always to blame? Clin Perinatol 2008; 35:35-52.

SOAP 2009