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Evaluating pre-delivery obstetric anesthesia consultations among obese parturients
Abstract Number: T1D-429
Abstract Type: Original Research
Background: Obesity is a contributing factor in over 50% of maternal deaths. Obesity in pregnancy is associated with increased risks of hypertensive disorders, venous thromboembolism, respiratory depression, and postpartum hemorrhage. In 2015, the American College of Obstetrics and Gynecology recommended that all obese parturients receive an anesthetic consultation prior to delivery to improve outcomes; however, the frequency and content of these consultations is largely unknown. The objectives of this study were to evaluate the proportion of women with BMI > 50 kg/m2 who received an anesthetic consultation prenatally, and evaluate the content of the consultations.
Methods: This retrospective, single-institution, cross-sectional study evaluated electronic medical record data for a preexisting dataset of all deliveries between 01/01/2015 and 12/31/2016 . Parturients with BMI > 50 kg/m2 were identified, and the chart was reviewed for a prenatal obstetric anesthesia consultation . If a consult was completed, the content of the consultation was extracted. A rubric containing 20 evidence-based recommendations was developed. Each consultation was assigned a score out of 20 possible points based on the number of recommendations communicated with the patient. Our primary outcome was the proportion of parturients with a BMI > 50 kg/m2 who received a prenatal obstetric anesthesia consultation.
Results: 167 parturients with a BMI > 50 kg/m2 were identified. Only 6 parturients (3 %) received prenatal obstetric anesthesia consults. The recommendations made in each consultation are shown in Table 1. The most frequent recommendations were implications for possible difficult intubation and the need for possible continuous pulse oximetry postoperatively.
Discussion: Our data suggest that obstetric anesthesia consultation for parturients with a BMI > 50 kg/m2 occurred rarely, and those that were performed were not comprehensive. This study highlights the need for both addressing barriers to prenatal consultation and standardizing recommendation content, as prenatal consultation may help reduce maternal morbidity and mortality in these high-risk parturients.