Modernization of anesthetic and resuscitative care in obstetrics as a factor of reducing maternal mortality

Seventy-one cases of maternal death caused by complications from anesthesia and resuscitation in the Russian Federation (RF) in 2005-2007 and on-line data on the organization of resuscitative care to pregnant women, parturients, and puerparas in 82 subjects of the RF are analyzed. The frequency of anesthesia and resuscitation has been ascertained to be 6.7% of the maternal death cases. Eight women died after less than 28-week pregnancy interruption, 5 during pregnancy, 12 at delivery, 41 in the postpartum period, and 5 after extrauterine pregnancy. The causes of female death were complications from general anesthesia (43.7%), anaphylactic shock in response to anesthetics (33.8%), complications from epidural anesthesia (8.5%), and complications from subclavian vein catheterization (7.0%). Outpatient care defects were revealed in 46.7% of the examinees and inpatient care ones were found in 74.6% of the dead women. In 2007, the RF obstetric facilities employed 3.500 anesthetists-resuscitators, 415 transfusiologists, had 1832 resuscitation beds, of them 560 beds were in regional (territorial, republican) perinatal centers (maternity hospitals). Remote obstetric resuscitation advisory centers with traveling resuscitative teams operate in 52 subjects of the RF. To reduce maternal mortality due to complications from anesthesia and resuscitation, it is necessary to set up a round-the-clock anesthetic service in the obstetric facilities, as well as obstetric resuscitative advisory centers, to extensively apply regional anesthetic modes, and to soundly use drugs, to introduce the health care standards, to upgrade the quality of training of medical personnel, and to develop telemedical technologies.

maternal mortality, anesthesia and resuscitation in obstetrics, organization of an anesthetic-resuscitative service in the obstetric hospital