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///2013 Abstract Details
2013 Abstract Details2019-08-02T16:57:45-05:00

Review of High Risk Obstetric Anesthesia Antepartum Consult Clinic – 2000 – 2012

Abstract Number: F 2
Abstract Type: Original Research

Fayaz Bharwani MD1 ; Alison Macarthur MD, MSC2

BACKGROUND: The management of high-risk pregnancies for women with significant medical co-morbidities is becoming an increasingly prominent responsibility for anesthesiologists.  At a tertiary-level teaching hospital in Canada, with a labor and delivery unit volume of 7000 deliveries per year, an obstetrical anesthesia antenatal clinic was established in 1999, to review high-risk parturients. Our study objective was to define the incidence of high-risk parturients seen at the antepartum anesthesia clinic between 2000 – 2011.  We hypothesized that the majority of high-risk parturients delivering at our institution were reviewed prior to delivery.

 

METHODS: This retrospective review identified all high risk antenatal anesthesia consultations during three representative years (2001, 2006, and 2011).  The proportion of high risk deliveries that had an anesthesia antenatal consultation was estimated by examining the total number of high risk deliveries in one randomly selected month from each of the three years. Data extracted from each anesthesia consultation included the primary indication for consultation, presence of secondary diagnoses, maternal age, gestational age at clinic visit, due date and parity.

 

RESULTS: A total of 1357 women attended the high-risk obstetrical anesthesia clinic during the 2001 (n=411), 2006 (n=427) and 2011 (n=519) calendar years.  The consultations were conducted on 6.3% (411/6485), 6.8%(427/6297) and 7.8% (519/6706 of all women delivering in 2001, 2006 and 2011 respectively.  The mean maternal age at time of consultation was 32.9 years (sd:+ 5.1).  52% were nulliparous and parturients were seen at an average gestational age of 34.3 weeks (sd: + 3.3). The number of patients per year seen in the clinic gradually increased over the last decade (p = 0.006). The three most common categories for maternal referral across the three years were cardiac (268/1357) representing 19.7% of all consults (95% CI: 17.6, 21.9); musculoskeletal (210 / 1357) representing 15.5% (95% CI: 13.6, 17.5); and hematologic (183/1357) representing 13.5% (95% CI: 11.6, 15.3).  While the pattern of primary diagnoses for consultation did not change over the three years sampled, obesity was the one exception.  Consultations due to obesity increased from 1% of all consults in 2001 to 12% in 2011 (p = 0.000).  There were increasing number of parturients with more than one high risk diagnosis over the years - 74 in 2001 (18%), 173 in 2006 (41%) and 276 in 2011 (53%). It was estimated that only 24.7% of eligible women for antepartum high risk obstetrical anesthesia consultation (1357/5484) were seen in the clinic during the three year review.

 

CONCLUSION: Future prospective studies are needed to confirm if there are substantial numbers of high-risk parturients missing an antepartum anesthesia assessment, and whether the consultations are important in improving clinical care and patient satisfaction.

SOAP 2013