Insights into obstetric anesthesia practices: a quantitative survey among physicians across Arab countries.
Anesthesia, Obstetrical
Arab countries
Major hospitals
Pregnancy
Surveys and questionnaires
Journal
BMC anesthesiology
ISSN: 1471-2253
Titre abrégé: BMC Anesthesiol
Pays: England
ID NLM: 100968535
Informations de publication
Date de publication:
28 Sep 2024
28 Sep 2024
Historique:
received:
08
08
2024
accepted:
13
09
2024
medline:
29
9
2024
pubmed:
29
9
2024
entrez:
28
9
2024
Statut:
epublish
Résumé
Obstetric anesthesia guidelines are essential for standardizing obstetric anesthesia practices globally and ensuring high-quality patient care. However, practices may vary across different settings, and there are limited data from Arab countries. This study aims to gain insights into obstetric anesthesia practices in several major hospitals across Arab countries. A questionnaire was emailed to 85 obstetric anesthesiologists/anesthesia chairpersons in major hospitals, including academic medical institutions and central hospitals, across 11/22 Arab countries. This survey gathered data on key structural and process-related obstetric anesthesia indicators. Out of 85 contacted, we had 56 responses (65.8%), with 41 being fully completed, providing insights into obstetric anesthesia indicators. Regarding structure: 31 (76%) hospitals had an operating room adjacent to the delivery room, all had intensive care units, and 22 (54%) had a lead obstetric anesthesiologist. For equipment, 19 (46%) had a video laryngoscope in the delivery suite, and 20 (49%) occasionally used ultrasound for epidurals. Regarding process: 33 (81%) held regular meetings, and 21 (51%) conducted research. Before epidural and spinal procedures, 26 (63%) and 28 (68%) required coagulation studies for patients without a history of hemorrhagic complications, while 38 (93%) and 36 (88%) mandated a platelet count, respectively. For labor analgesia, 34 (83%) primarily used epidurals, and 15 (37%) placed preemptive catheters in high-risk pregnancies. For cesarean delivery, 40 (98%) used spinals, with 16 (39%) using intrathecal morphine and 22 (54%) administering aspiration prophylaxis before general anesthesia. Regarding spinal-induced hypotension, 6 (15%) used prophylactic phenylephrine infusion. This survey highlights variations in obstetric anesthesia practices among various major hospitals in several Arab countries, compared to international recommendations. It emphasizes the need for obstetric anesthesia registries in the Arab world for future research. Further studies are required to outline country-specific practices, improve resource allocation, and enhance obstetric population safety and satisfaction.
Sections du résumé
BACKGROUND
BACKGROUND
Obstetric anesthesia guidelines are essential for standardizing obstetric anesthesia practices globally and ensuring high-quality patient care. However, practices may vary across different settings, and there are limited data from Arab countries. This study aims to gain insights into obstetric anesthesia practices in several major hospitals across Arab countries.
METHODS
METHODS
A questionnaire was emailed to 85 obstetric anesthesiologists/anesthesia chairpersons in major hospitals, including academic medical institutions and central hospitals, across 11/22 Arab countries. This survey gathered data on key structural and process-related obstetric anesthesia indicators.
RESULTS
RESULTS
Out of 85 contacted, we had 56 responses (65.8%), with 41 being fully completed, providing insights into obstetric anesthesia indicators. Regarding structure: 31 (76%) hospitals had an operating room adjacent to the delivery room, all had intensive care units, and 22 (54%) had a lead obstetric anesthesiologist. For equipment, 19 (46%) had a video laryngoscope in the delivery suite, and 20 (49%) occasionally used ultrasound for epidurals. Regarding process: 33 (81%) held regular meetings, and 21 (51%) conducted research. Before epidural and spinal procedures, 26 (63%) and 28 (68%) required coagulation studies for patients without a history of hemorrhagic complications, while 38 (93%) and 36 (88%) mandated a platelet count, respectively. For labor analgesia, 34 (83%) primarily used epidurals, and 15 (37%) placed preemptive catheters in high-risk pregnancies. For cesarean delivery, 40 (98%) used spinals, with 16 (39%) using intrathecal morphine and 22 (54%) administering aspiration prophylaxis before general anesthesia. Regarding spinal-induced hypotension, 6 (15%) used prophylactic phenylephrine infusion.
CONCLUSION
CONCLUSIONS
This survey highlights variations in obstetric anesthesia practices among various major hospitals in several Arab countries, compared to international recommendations. It emphasizes the need for obstetric anesthesia registries in the Arab world for future research. Further studies are required to outline country-specific practices, improve resource allocation, and enhance obstetric population safety and satisfaction.
Identifiants
pubmed: 39342099
doi: 10.1186/s12871-024-02728-x
pii: 10.1186/s12871-024-02728-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
341Informations de copyright
© 2024. The Author(s).
Références
Royal College of Anaesthetists. Guidelines for the Provision of Anaesthesia Services for an Obstetric Population. 2023. [cited 2024 May 2]. https://rcoa.ac.uk/sites/default/files/documents/2023-02/Chapter%209%20Guidelines%20for%20the%20Provision%20of%20Anaesthesia%20Services%20for%20an%20Obstetric%20Population%202023.pdf
Practice Guidelines for Obstetric Anesthesia. Anesthesiology. 2016;124(2):270–300. https://doi.org/10.1097/aln.0000000000000935.
doi: 10.1097/aln.0000000000000935
ACOG practice bulletin no. 209: Obstetric analgesia and anesthesia. Obstet Gynecol. 2019;133(3):e208–25. doi:10.1097/aog.0000000000003132
Wagstaff DT, Bulamba F, Fernando R. Obstetric anaesthesia over the next 10 years: Africa and Middle East. Int J Obstet Anesth. 2023;55:103877. doi: 10.1016/j.ijoa.2023.103877.
Health Trends in the Middle East and North Africa | HFG [Internet]. Hfgproject.org. 2018. https://www.hfgproject.org/health-trends-in-the-middle-east-and-north-africa/
Bishop DG, Fernandes NL, Dyer RA, Sumikura H, Okada H, Suga Y, et al. Global issues in obstetric anaesthesia: perspectives from South Africa, Japan, China, Latin America and North America. Int J Obstet Anesth. 2023;54:103648. https://doi.org/10.1016/j.ijoa.2023.103648 .
doi: 10.1016/j.ijoa.2023.103648
pubmed: 36930996
The EQUATOR. Network | Enhancing the QUAlity and Transparency Of Health Research. www.equator-network.org . https://www.equator-network.org
Lab S. Scimago Institutions Rankings. Scimagoir.com. Published 2024. Accessed August 5, 2024. https://www.scimagoir.com/rankings.php?sector=Health&country=ARAB%20COUNTRIES
Halliday L, Nelson SM, Kearns RJ. Epidural analgesia in labor: a narrative review. Int J Gynaecol Obstet. 2022;159(2):356–64. https://doi.org/10.1002/ijgo.14175.
doi: 10.1002/ijgo.14175
pubmed: 35277971
Lim G, Facco FL, Nathan N, Waters JH, Wong CA, Eltzschig HK. A review of the impact of obstetric anesthesia on maternal and neonatal outcomes. Anesthesiology. 2018;129(1):192–215. https://doi.org/10.1097/aln.0000000000002182 .
doi: 10.1097/aln.0000000000002182
pubmed: 29561267
Van Zundert AAJ. Safety in obstetric anesthesia requires more research and support. Front Anesthesiol. 2023;2. https://doi.org/10.3389/fanes.2023.1249720 .
Liberati EG, Tarrant C, Willars J, Draycott T, Winter C, Kuberska K, et al. Seven features of safety in maternity units: a framework based on multisite ethnography and stakeholder consultation. BMJ Qual Saf. 2021;30(6):444–56. https://doi.org/10.1136/bmjqs-2020-010988 .
doi: 10.1136/bmjqs-2020-010988
pubmed: 32978322
Guasch E, Ioscovich A, Brogly N, Orbach-Zinger S, Kranke P, Morau E, et al. Obstetric anaesthesia manpower and service provision issues (introduction and European perspective). Int J Obstet Anesth. 2023;55:103647. https://doi.org/10.1016/j.ijoa.2023.103647 .
doi: 10.1016/j.ijoa.2023.103647
pubmed: 37085390
Mallaiah S, Barclay P, Harrod I, Chevannes C, Bhalla A. Introduction of an algorithm for ROTEM-guided fibrinogen concentrate administration in major obstetric haemorrhage. Anaesthesia. 2015;70(2):166–75. https://doi.org/10.1111/anae.12859 .
doi: 10.1111/anae.12859
pubmed: 25289791
Snegovskikh D, Souza D, Walton Z, Dai F, Rachler R, Garay A, et al. Point-of-care viscoelastic testing improves the outcome of pregnancies complicated by severe postpartum hemorrhage. J Clin Anesth. 2018;44:50–6. https://doi.org/10.1016/j.jclinane.2017.10.003 .
doi: 10.1016/j.jclinane.2017.10.003
pubmed: 29121548
McNamara H, Kenyon C, Smith R, Mallaiah S, Barclay P. Four years’ experience of a ROTEM
doi: 10.1111/anae.14628
pubmed: 30950521
Krawczyk P, Dabrowska D, Guasch E, Jörnvall H, Lucas N, Mercier FJ, et al. Obstetric units’ preparedness to manage critically ill women. The second report from the MaCriCare study. Anaesth Crit Care Pain Med. 2024;43(4):101394. https://doi.org/10.1016/j.accpm.2024.101394 .
doi: 10.1016/j.accpm.2024.101394
pubmed: 38795829
Gupta S, Grewal A, Jain K. Obstetric anaesthesiology: manpower and service provision issues in India. Int J Obstet Anesth. 2024;57:103928. https://doi.org/10.1016/j.ijoa.2023.103928 .
doi: 10.1016/j.ijoa.2023.103928
pubmed: 37858417
Betran AP, Ye J, Moller A-B, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021;6(6):e005671. https://doi.org/10.1136/bmjgh-2021-005671 .
doi: 10.1136/bmjgh-2021-005671
pubmed: 34130991
pmcid: 8208001
Al Jalam Dr, Isra Abu Amra YSKPABDSKDM. Rate, causes, and risk factors of caesarean section in north of Jordan and its associated maternal and perinatal risks [Internet]. Who.int. [cited 2024 May 2]. https://www.emro.who.int/images/stories/rpc/Research_in_priority_areas_of_public_health/rpph-16-32.pdf?ua=1
Eisenach JC, Pan PH, Smiley R, Lavand’homme P, Landau R, Houle TT. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain. 2008;140(1):87–94. https://doi.org/10.1016/j.pain.2008.07.011 .
doi: 10.1016/j.pain.2008.07.011
pubmed: 18818022
pmcid: 2605246
Siddik-Sayyid SM, Taha SK, Kanazi GE, Aouad MT. A randomized controlled trial of variable rate phenylephrine infusion with rescue phenylephrine boluses versus rescue boluses alone on physician interventions during spinal anesthesia for elective cesarean delivery. Anesth Analg. 2014;118(3):611–8. https://doi.org/10.1213/01.ane.0000437731.60260.ce .
doi: 10.1213/01.ane.0000437731.60260.ce
pubmed: 24299932
Onajin-Obembe BOI. Equity in provision and access to obstetric anaesthesia care in Nigeria. Int J Obstet Anesth. 2023;54:103642. https://doi.org/10.1016/j.ijoa.2023.103642 .
doi: 10.1016/j.ijoa.2023.103642
pubmed: 36841064
Haylock-Loor C, Guevara J. Impact of conflict and pandemic on women’s health in Latin America: implementation to improve equity in the provision and access to safe obstetric anesthesia. Int J Obstet Anesth. 2023;55:103651. https://doi.org/10.1016/j.ijoa.2023.103651 .
doi: 10.1016/j.ijoa.2023.103651
pubmed: 37117101
Golubovska I, Palmer C, Ronenson A, Shifman E, Sarkele M, Pejcic N, et al. Where is obstetric anesthesiology heading in the next decade? An eastern European perspective. Int J Obstet Anesth. 2023;56:103931. https://doi.org/10.1016/j.ijoa.2023.103931 .
doi: 10.1016/j.ijoa.2023.103931
pubmed: 37801899
Guasch E, Brogly N, Mercier FJ, Ioscovich A, Weiniger CF, Lucas N, et al. European minimum standards for obstetric analgesia and anaesthesia departments: an experts’ consensus. Eur J Anaesthesiol. 2020;37(12):1115–25. https://doi.org/10.1097/EJA.0000000000001362 .
doi: 10.1097/EJA.0000000000001362
pubmed: 33074944
Krawczyk P, Dabrowska D, Guasch E, Jörnvall H, Lucas N, Mercier FJ, et al. Preparedness for severe maternal morbidity in European hospitals: the MaCriCare study. Anaesth Crit Care Pain Med. 2024;43(3):101355. https://doi.org/10.1016/j.accpm.2024.101355 .
doi: 10.1016/j.accpm.2024.101355
pubmed: 38360406
Bishop D, van Dyk D, Dyer RA. Safe obstetric anaesthesia in low- and middle-income countries—a perspective from Africa. BJA Educ. 2023;23(11):432–9. https://doi.org/10.1016/j.bjae.2023.07.003 .
doi: 10.1016/j.bjae.2023.07.003
pubmed: 37876763