The obstetrical anaesthesia assessment clinic: a review of six years experience.

We reviewed the out-patient consultation notes of 136 pregnant women seen at the Ottawa Civic Hospital from 1985 to 1991 to evaluate the efficacy of an Obstetric Anaesthesia Assessment Clinic (OAC). In addition, their anaesthetic records from labour and delivery were reviewed. For each patient the reason for referral was recorded according to the involved organ system. The anaesthetic management at delivery was compared with the proposed anaesthetic plan by the OAC consultant (obstetric anaesthetist). The majority of women 84 (62%) had complaints related to the musculo-skeletal system. In addition, 18 patients were referred because of previous anaesthetic problems, ten with a history of cardiac disease, and eight with neurological disease. Lumbar epidural analgesia (LEA) was a safe and effective choice for parturients with low back pain, history of lumbar fractures or single level discectomies without lumbar fusion. Parturients with posterior instrumentation experienced an increased incidence of inadequate pain relief from LEA. Individualized anaesthetic management plans were executed for parturients with spina bifida occulta, neurological, cardiac, and haematological disease as well as for women, with a history of adverse drug reactions and previous problems with regional or general anaesthesia. It is concluded that the OAC has provided a valuable service to obstetricians and anaesthetists for the anaesthetic management of pregnant women with co-existing disease. The OAC gave an opportunity for patient education regarding anaesthetic options for labour and delivery. The attending anaesthetist was provided with a risk assessment and anaesthetic management plan which was adhered to with only two exceptions. Finally, the obstetrician was given consistent advice regarding anaesthesia management that may affect obstetrical decisions.