Obstetric Anaesthesia Annual Scientific Meeting 2026

The Importance of Clarifying Assumptions in MDT Decision Making: Lessons from a Chiari Malformation Case.

Keira Jones, Anna Marlborough, Juliana Sisk.
Department of Anesthesia, Glasgow Royal Infirmary and Princess Royal Maternity Hospital.

Introduction
•Obstetric patients with Chiari malformation prompt MDT discussion regarding the safety of neuraxial anaesthesia.
•Existing literature focuses on clinical risk and outcomes associated with mode of delivery1.
•Less attention to how inter-specialty assumptions and communication influence decision making.
•Upcoming publication from OAA on anaesthetic management of Chiari in Obstetrics.

Case Presentation

•34-year-old para 2 with Chiari I malformation and associated syringomyelia.

•Previous planned caesarean changed last minute to general anaesthesia → negative birth experience.

•Initial neurosurgical advice against neuraxial technique.

•Later recognised as assumption equating spinal anaesthesia with familiar CSF drainage procedures.

•Consultant-to-consultant discussion between anaesthetist and neurosurgeon clarified plan: single-shot spinal using 25G pencil-point needle. Standard obstetric technique with minimal CSF flow.

•Neurosurgeon acknowledged misunderstanding of spinal anaesthesia.

•Discussion included benefits: improved maternal pain relief and benefits for baby.

•Outcome: clearer, collaborative, patient-centred delivery plan.

Discussion

•Increasing subspecialisation may create unrecognised gaps in shared procedural knowledge.

•Common terminology can lead to assumptions and overly cautious recommendations.

•Explicit clarification of technique, sharing of literature, and open consultant-level dialogue were central to achieving MDT consensus.

•Regional may also confer advantages for baby2.

• This case illustrated not only the clinical implications, but also the potential psychological and relational consequence for patient.

References:
1. Simpson, A. and Ferguson, C. (2024) ‘Anaesthetic management of obstetric patients with Chiari Type I malformation: A retrospective case series and literature review’, International Journal of Obstetric Anaesthesia, 60, p. 104232. doi:10.1016/j.ijoa.2024.104232.
2. Kearns RJ, Shaw M, Gromski PS, Iliodromiti S, Pell JP, Lawlor DA, Nelson SM. Neonatal and early childhood outcomes following maternal anesthesia for cesarean section: a population-based cohort study. Regional Anesthesia and Pain Medicine. 2021 Jun;46(6):482-489. doi: 10.1136/rapm-2020-102441

Obstetric Anaesthesia Annual Scientific Meeting 2026

The importance of clarifying assumptions in multidisciplinary decision-making: lessons from a Chiari Malformation case

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