215 posters, 5 topics, 22 sessions, 596 authors, 283 institutions
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Obstetric Anaesthesia Annual Scientific Meeting 2025
May 15 - 16, 2025 | ICC, 2 Lanyon Place, Belfast BT1 3WH
6780074
Balancing safety and resource provision: Should we revise BMI thresholds for referral to high-risk anaesthetic clinic?
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Part of Topic
Quality Improvement
Balancing safety and resource provision: Should we revise BMI thresholds for referral to high-risk anaesthetic clinic?
Introduction
- Obesity in pregnancy is associated with increased maternal and fetal morbidity & mortality
- The RCOG recommends antenatal anaesthetic referral for women with BMI ≥40kg/m²
- Our High-Risk Anaesthetic Clinic (HRAC) has capacity to see ~400 women/year
Aim: To evaluate RA use, technical challenges, and outcomes in women with BMI ≥40, to inform future referral thresholds
Methods
- Design: Retrospective review (12 months)
- Population: Women with BMI ≥40kg/m² at booking
- Timeframe: 01/04/2023 – 31/03/2024
- Data Collected:
Patients Identified: 143
- Excluded: 21 (Pregnancy loss, relocation, record issues)
- Final Cohort: 122 women
Mode of Delivery
Regional Analgesia (RA):
- RA administered: 95 women
- Documented as difficult: 22 (23%)
- Re-sites required: 2
- Depth >8 cm: 12 (13%) – No strong correlation with BMI
HRAC Referrals:
- Referred: 73 women (60%)
- Seen: 64 (88% of referred)
Represents 1–2 HRAC appointments per clinic
Discussion & Implications
- Majority of RA performed by ST5-7 or Consultant Anaesthetists. This is due to the staffing in out unit but we acknowledge is not the norm nationally.
- Long needles were available, but 8cm needle was sufficient in most cases.
- Almost half delivered without RA
Key Messages
RA generally successful and safe, even in high BMI
Limited correlation between BMI and depth of epidural space
Antenatal anaesthetic assessment is unlikely to impact on quality of care or safety in all women with BMI >40 kg/m2
Proposed Actions