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Advancing Obstetric Anesthesia Practice in a Tertiary Care Maternity in Romania: The Kybele Experience
Abstract Number: O1 2
Abstract Type: Original Research
Introduction: Despite joining the European Union in 2007, Romania continues to deal with many health care challenges. The practice of obstetric anesthesia is not different, with no uniform practices and a lack of standardized guidelines. Kybele (www.kybeleworldwide.org) is a 501 (c) (3) non-profit humanitarian organization founded in 2001 to promote safe childbirth worldwide through collaboration partnerships. In 2009 a Kybele team of obstetric anesthesiologists was invited by the Romanian Society of Anesthesia and the leadership of the Cuza Voda Maternity in Iasi, Romania, to establish a working partnership for improving childbirth practices. The Cuza Voda maternity in Iasi is a tertiary care obstetric center with the highest number of deliveries in Romania. In 2007, the Cesarean delivery (CD) rate was 36%, mostly done under general anesthesia. Between 2009-2011, Kybele teams of obstetric anesthesiologists, obstetricians and neonatologists visited Cuza Voda maternity once per year, working with the local physicians. We present the impact of the Kybele outreach program on obstetric anesthesia practice in this maternity unit.
Methods: The Kybele team spent one week each yearly visit, as hands-on workshops were organized for 10-15 anesthesiologists from the region, joining the anesthesiologists from Iasi. Neuraxial techniques for CD and labor analgesia were taught. The Kybele team also introduced the concept of changing the timing of prophylactic antibiotic administration to being before skin incision rather than after umbilical cord clamping and a small observational study was performed to evaluate this practice.
Results: Changes in anesthesia practice from pre-Kybele visit in 2007 are summarized in the table. The use of spinal anesthesia for CD increased from 19 % in 2007 to 78 % in 2011. Use of labor epidural analgesia however remains largely unchanged. The observational study involved 318 patients and found a numerically lower infection rate with pre-incisional compared with post-delivery antibiotic administration (12 % vs. 18 %).
Conclusions: The outreach program in Romania had a significant impact on the practice of obstetric anesthesia. Specifically, there was a change in anesthesia techniques for CD with the majority now being performed under spinal anesthesia. There was however no significant change in the number of labor epidurals, due to personnel and logistical problems. The practice of antibiotic administration also changed.