INTRODUCTION

There is a stark paucity of literature regarding the psychological impact of anaesthetic complications during childbirth or best practise guidance on post-natal management. St George’s Obstetric Anaesthesia Department recognised this shortfall and developed a post-natal anaesthetic review clinic (PNARC) in 2019. To our knowledge, this is the first description of the set up and audit of an anaesthetic post-natal clinic.

POST-NATAL ANAESTHETIC REVIEW CLINIC SET-UP

PNARC reviews patients following anaesthetic complications during childbirth at approximately six weeks post-partum predominantly via telephone consultation. The purpose is to allow for a thorough debrief of the anaesthetic complication, to answer the patients’ questions and ultimately provide reassurance to patients that actions can be taken to mitigate the risk of reoccurrence in future deliveries.

Referrals are made via a dedicated referral e-mail address which is regularly monitored and can be made by any member of the obstetric multi-disciplinary team (eg obstetricians, midwives or anaesthetists). Patients are referred either at the point of complication or during routine inpatient follow up.

After PNARC had been established for over one year, the audit department approved an audit of the first 100 referrals.

AUDIT RESULTS

Of the first 105 referrals, 90 patients warranted PNARC review.

84 patients attended a scheduled PNARC appointment

82% had a telephone consultation

18% had an in-person consultation
3 patients had appointments pending
3 patients were followed-up by the Obstetricians.
14 patients did not respond to attempts to schedule an PNARC appointment 1 patient did not attend their scheduled appointment

The indications for referral to PNARC are demonstrated in figure 2.

NEUROLOGY PATHWAY

A new care pathway for patients with suspected neurological injury post neuraxial anaesthesia was developed with our Neurology service (see figure 1) and provides rapid access to outpatient clinic appointments after vetting by a neurologist.
During the audit period 14 patients were referred to Neurology rapid access clinic using the new pathway, 2 patients with ongoing headache post dural puncture and 12 with suspected peripheral nerve injury post regional anaesthesia.

The 2 patients with post-dural puncture headache both had normal MRI scans and underwent further investigation in neurology clinic, their symptoms had improved at the time of final review. Figure 3 demonstrates the outcomes of patients that were referred to Rapid Access Neurology clinic with suspected peripheral nerve injury.