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Obstetric anesthesia in Armenia: progress over an eight year journey
Abstract Number: F-28
Abstract Type: Original Research
Background: The Republic of Armenia, a mountainous country in the South Caucasus, has a population of 3.3 million and was classified as a lower middle-income country by the World Bank in 2012.1,2 Currently 65% of the population lives in urban areas with 33% in the capital city of Yerevan.1
Cesarean delivery in Armenia has historically been conducted with general anesthesia and the use of epidural labor analgesia is uncommon. Kybele, a non-profit humanitarian organization, was invited to visit Armenia to conduct training in the standards and use of obstetric regional anesthesia. The aim of this report was to assess the impact of training on the use of regional anesthesia techniques for obstetrics in Armenia.
Methods: Kybele conducted five visits to Armenia between 2006 and 2014. The structure for each visit included a multi-national multi-disciplinary team, delivering a 1-2 day national conference in Yerevan and 2-5 day site visits to participating hospitals throughout the country. The Armenian Society of Anesthesiologists and Intensive Care Specialists collected data on the numbers of vaginal delivery, cesarean section, and regional anesthesia use in maternity units during the period. Data were analyzed with Fisher’s exact test or Chi-square, as appropriate.
Results: In nine hospitals providing obstetric care in Yerevan, regional anesthesia use for cesarean delivery increased significantly (p<0.0001) between 2006 and 2013. There was also a significant increase in the use of labor epidural analgesia in seven of the nine hospitals (p<0.0001), although all but two hospitals had low utilization (<10%). In hospitals located outside the capital city, the use of regional anesthesia for cesarean delivery increased significantly more in hospitals that received an external visiting team than in those that did not (p<0.0001). Regional labor analgesia outside the capital city did not occur, except in one hospital located in the Nagorno-Karabakh Republic, where it was 4% in 2012 and 8% in 2013. Hospitals visited during the program accounted for over half the registered births each year in Armenia.
Conclusion: Through a targeted multi-year collaborative educational intervention the use of regional anesthesia for cesarean delivery consistently increased in Armenia, both within the capital city and in other parts of the country. Epidural labor analgesia also increased within Yerevan.
1. Health Syst Transit 2013; 15(4): 1-99
2. The World Bank. http://data.worldbank.org