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

Anesthesia for Cesarean Section at a Tertiary Hospital in Accra, Ghana: The Results of an International Collaboration

Abstract Number: 163
Abstract Type: Original Research

Medge Owen MD1 ; Adeyemi Olufolabi MD2; Holly Muir MD3; Vernon Ross MD4; Wendy Gore-Hickman MD5; Johnathan Kuma MD6

Introduction: In Africa, the use of general anesthesia for Cesarean section (CS) may account for as many as 5-7 % of hospital-based maternal deaths, occurring in both healthy and medically compromised patients.1-4 Unfortunately, many African anesthesia providers may not have knowledge or training utilizing regional anesthesia for CS. In January 2007, the Ghana Health Service and Kybele (www.kybeleworldwide.org) began a 5 year collaboration at Ridge, a tertiary hospital in Accra, to improve childbirth safety; this was following a preliminary site visit in January 2006. As part of the collaboration, type of anesthesia for CS was assessed and an educational program (EP) was designed. The purpose of this study was to evaluate the effectiveness of the EP in reducing the use of general anesthesia for CS.

Methods: Kybele was granted institutional permission to develop an EP. International medical teams traveled to Ghana 7 times in 2006-2008, to provide 1-2 weeks of on-site training and follow-up. Ghanaian anesthesia providers received didactic and practical training in the use of spinal anesthesia for CS including, sterile preparation, needle selection, interspace identification, local anesthetic dosage, sensory block assessment and hemodynamic monitoring. A triage system based on the 30 min rule was also introduced to reduce delay in initiating surgery for maternal or fetal distress. Data was collected for the type of anesthesia for CS and maternal mortality, but not for delay. Statistical analysis was performed with Chi-square (p < 0.05).

Results: In 2005, the use of regional anesthesia for CS at Ridge Hospital was 1%. Following the EP, the use of regional anesthesia for CS significantly increased (Table). During the same time, there was a large increase in the number of CS performed. In 2008, there was a decrease in maternal mortality.

Conclusion: The reduction in maternal mortality at Ridge Hospital is encouraging and may be related to an increase in the use of regional anesthesia for CS. It is more likely, however, that mortality reduction is based on multiple factors associated with the EP.

References: (1)Acta Anaesthesiol Scand 2006;50:206-10. (2)IJOA 2002;11:77-80. (3)IJOA 1998;7:237-41. (4) BMJ 2003;327:587-90.

Acknowledgement: This work was supported by educational grants from the Obstetric Anaesthetists Association (OAA) and the International Association for the Study of Pain (IASP).

SOAP 2009