I n recent years there have been several reports of serious maternal morbidity and mortality in association with obstetric epidural analgesia. ~ An examination of present practices in obstetric epidural services was proposed in which particular attention would be paid to measures used to prevent and warn of potentially life-threatening complications. MctiiodYA questionnaire t was designed to enquire into the medical responsibility and provision of the epidural service and the subscqucnt care of mothers in rcceipt of an cpidural. One section enquired into details of top-up injections and subsequent patient monitoring. Information was sought about methods of recognition and treatment of complications while an epidural was in progress, as well as the relevant training and updating of midwives in areas that included cardiopulmonary resuscitation of the obstetric patient. Thc questionnaire included a section on the siting of first-line resuscitation equipment and drugs in relation to the mothers. Thcrc was also a section on epidural recordkeeping. Finally, the extent of information afforded to paticnts about obstetric analgesia and, more specifically, on epidurals and possible complications, and the manner in which mothers' consent was obtained prior to the procedure. were also included in the questionnaire. An urban Regional Health Authority which offered a good crosssection of obstetric units was studied.The investigation was started in the second half of 1985. An introductory letter which described the study and its aims was sent to the person in charge of the obstetric epidural service at each of the obstetric units of the region under study, with the assurance that the source or information would remain confidential. This was followed by an appointment and visit by the research midwife co-authoring this study. The questionnaire was completed by the respondent in the presence of the research midwife. When the respondent was uncertain of the answer to any question that related to the practices commonly followed in that unit, the research midwife interviewed the senior registrar currcntly in charge of obstetric analgesia or a senior niidwife from that hospital's labour ward. as appropriate, to provide the missing information. The consultant anaesthetists in charge of obstetric analgesia and anaesthesia in two teaching hospitals under study were unable L O arrange a meeting with the research midwife and they completed the questionnaire by post. Ri1sult.vThe 1-cgion studied included six university affiliated hospitals. 14 district general hospitals and two independcnt hospitals. The obstetric units in onc of the teaching and four of thc district hospitals were isolated from the main hospital.S i x of' ohstetric unit und epidural rate. The number of deliveries per year was more than 4000 in one teaching and onc district hospital, between 2501 and 4000 again in one teaching and one district hospital. between 1001 and 2500 in three teaching and I2 district hospitals, betwccn 501 and 1000 in one teaching hospital and les...

,411 inoc.stigution into prcictices of' th[. epidurul services in a regionul sarnple of' obstetric units IVLIS undertakrn ,fijllowing reciwt reported dkasters associated with epidural analgesia for labour pain. A questionnaire ~c'as completed by all 22 obstetric* units in thc region, which included .six teaching. 14 district and two independent centres. In three units the epidural swviee was sliurucl with the obstetricians. A continuous unaesthetic presence wus provided in 16 of' 22 units. There M.'US consiileruble variation in the uttrndunce u p n epidural patients bv the unaesthetists. Instructions to rnidk$*ives ,for top-ups and subsequent core of puticnts ,follo~retl no uniform pattern. Midhi@e in-service training in tlzr initial munagenzrnt of' ,rcriou.s. epidural r.otnplii~ution.r nnd in c~irdio~piclmoiiar~~ resuscitation bt'us inconsistent. h some units, the uvoidance (if aortocaval compression as not emphusised in the nianugement of serious complications such as severe maternal kj)pvtension, totul spinal blockode or curdim arwst of' tliv parruricnt. Thc results obtained in this survey suggesst that there is u nerd to review rhr requirements in thc prori.rion of ohstctric c~piiluriil scv-vices and considerut ion sliould be given to the estahli.rhmcnt of a Rtwrully accepted stanu'md of practice.

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