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Information and Consent for Elective/ Planned Caesarean Section
Abstract Number: S-26
Abstract Type: Original Research
Following an incident at a UK district general hospital related to regional anaesthesia(RA) for an elective Caesarean section(eCS), the National Health Service Litigation Authority(NHSLA) made recommendations on how women are consented for eCS. These included documenting all risks discussed with the woman; ensuring that all women have had an opportunity to read written material explaining the choices, benefits and risks of anaesthesia(A) for eCS; that all women having an eCS should be routinely offered a general anaesthetic(GA).
We wanted to know if, how and when other units provided parturients with written information regarding eCS, which risks were discussed and whether a GA is routinely offered to all women undergoing eCS.
A national survey using the Obstetric Anaesthetist's Association (OAA) survey tool with 7 questions addressing the above issues was sent to all OAA members.
1930 members were invited; 45% complete responses were received. 73% of respondents were consultants.
50% of responses confirmed that ALL women receive written information regarding A for eCS. 76% of responses confirm that this information is given to women at booking or at A clinic. Nearly 100% of responses confirm that women receive verbal information prior to receiving A. When consenting for RA before eCS only 12.7% of respondents warn women about failure of RA and conversion to GA.
76% of respondents do not routinely offer GA for eCS. When consenting for GA for eCS only 5% of respondents routinely warn about the risk of awareness and 12.9% warn about airway complications and the risk of aspiration.
Only 50% of respondents could confirm that all women receive written information regarding A for eCS and only 76% can confirm that they receive it before attending labour suite on the day of surgery. The AAGBI Consent for Anaesthesia Guideline recommends that every obstetric unit should provide antenatal advice for women concerning analgesia and A during labour and delivery prior to its occurrence. We should emphasise the point of this guideline and try to improve current practice.
Under 13% of responding anaesthetists in the UK warn women about the risk of conversion of a RA to GA and only 24% offer GA for eCS routinely. This does make us question how valid the NHSLA recommendation on offering a GA to all women undergoing an eCS would be, particularly if tested under the Bolam and Bolitho principles, and in light of the most recent 5th National Audit Project which shows an incidence of awareness of 1/670 in the obstetric population. We are also wary of the risks attached to GA in the obstetric population for CS incl the increased risk of difficult and failed intubation; potential for uterine relaxation with increased blood loss; and inferior postoperative analgesia. Along with the majority of respondents to our survey, we believe that GA should not be routinely offered for eCS.
1. AAGBI Consent for Anaesthesia. January2006
2. NAP4. Br J Anaesth 2014 doi 10.1093/bja/aeu31