Selected prize abstracts from the Australian and New Zealand College of Anaesthetists Annual Scientific Meeting and the Obstetric Anaesthesia SIG Satellite Meeting, May 2023, Sydney, Australia

Obesity during pregnancy is an evolving global epidemic associated with poor maternal and foetal outcomes.1 This is a pilot audit at KEMH, WA’s maternity hospital, evaluating the anaesthetic practice involving parturients with BMI ≥50 kg/m2 against institutional policy. The clinical standards measured are: MethodsThis retrospective audit received institutional approval (#40066) and involved data collection of anonymised cases with BMI≥50 kg/m2 from July 2020 to June 2021 for labour and delivery presentations, spontaneous or induced, and elective or emergency Caesarean sections (CS). Results6332 clinical encounters were recorded. 90 (1.42%) met inclusion criteria with 86 (1.36%) requiring anaesthetic intervention. Amongst the 90, 58.9% were reviewed in HRAC, 36.7% at the recommended gestation. 74.4% were admitted electively while 18.9% were managed emergently.97.2% received an epidural (19.4% CSE) for labour analgesia. 94.3% of neuraxial placements were inserted early. Amongst the elective CS, 90.3%, 6.5% and 3.2% received CSE, spinal and general anaesthetic respectively.The average length of hospital stay was 5.3 days with the majority (62.2%) admitted for under 5 days. 17.8% patients needed higher level care for conditions such as post-partum haemorrhage. DiscussionThe audit discovered a lower-than-expected rate of HRAC review, especially for 28–34 gestational weeks. The reasons were unclear. Some postulations include a lack of patient or policy compliance and poor clinic attendance during the COVID-19 pandemic. There was also a scarcity of data on the notification of anaesthetic staff but all high-risk cases presenting to the birthing suite are routinely discussed at the multidisciplinary meeting twice daily.It also highlighted some specific challenges encountered including the close involvement of senior clinicians to site an epidural (59.1%), the use of neuraxial ultrasound (10.6%), longer 120 mm epidural needle (20%) and more than one attempt to site an epidural (40.9%). A low rate of early epidural insertion (5.7%) was noted.Despite limited evidence-based data to support having antenatal anaesthetic review and early initiation of epidural,2 the established clinical standards should be supported. The benefits include early identification and optimisation of obesity-related medical issues, timely discussion with senior colleagues and organising appropriate bariatric equipment. Early epidural improves patient comfort, labour experience, success of epidural insertion and allows a working epidural to provide surgical anaesthesia, thus avoiding GA.1Moving forward, a streamlined referral process and a robust perioperative checklist for this group of parturients is recommended to improve patient care and service delivery.