The critical role of obstetric anaesthesia in low-income and middle-income countries.

Abstract

In the current issue of The Lancet Global Health Soha Sobhy and colleagues have compiled the first systematic review and meta-analysis of anaesthesia-related maternal mortality in low-income and middle-income countries. They find that anaesthesia contributes 2·8% of all maternal deaths in these settings. Although this percentage is small the overall frequency of anaesthesia-related maternal death is 300-fold higher for neuraxial anaesthesia and 900-fold higher for general anaesthesia than that reported for the USA (1·2 per 1000 women undergoing an obstetric procedure vs 3·8 per million and 5·9 per 1000 vs 6·5 per million respectively). This disparity highlights a significant opportunity for improvement in safe childbirth worldwide because anaesthesia-related maternal mortality is almost always preventable. Massive open online courses and open access electronic journals and textbooks show promise to rapidly expand access to information. Electronic networks that connect learners with technical experts may be an effective strategy to spread expertise around the globe. But investigations into specific clinical contexts are needed to identify and address local factors that impede and facilitate improvements in care and at the same time define generalisable principles of how to accelerate innovations in perioperative patient safety. It is gratifying that obstetric surgery has finally emerged as a global health priority and that this systematic review published in The Lancet Global Health points to the critical role of obstetric anaesthesia in ensuring the safety of childbirth around the world. (Excerpts) Copyright © Mhyre. Open Access.