[Anaesthesia and obstetrics: the role of the French 1998 laws in childbirth safety].
Introduction of new legal texts in 1994-1995 has certainly contributed to the improved safety of anaesthesia practice in France. More recently also legal texts have been published in this country to improve the practice of obstetrics. These two series of texts have had a significant impact on obstetric anaesthesia, improving care directly related to anaesthesia practice (such as visit with an anaesthetist during pregnancy for every patient) but also care of patients with maternal disease through the implementation of regionalisation and of perinatal networks. Significant problems however need to be solved if one wants that improvement in quality continues. Precise evaluation of practice patterns and of outcomes will become possible only when well-defined indicators will have been found and accepted. Also, regionalisation of obstetric services has led to a profound change in workload with an increase in both anaesthesic procedures and stress related to urgency situations in tertiary level perinatal units. Regionalisation has been introduced to reduce perinatal mortality and morbidity. However, maternal complications of obstetric or of pre-existing diseases may require specific competence that may not be available in perinatal centres specifically organized to improve neonatal outcome. High-level perinatal centres should thus be able to care for both the mother and the neonate. Alternatively, when not feasible, specific rules or protocols should be made available to optimize the transfer while taking into account the severity of maternal disease. All these continuing improvements will however be possible only if shortage of specialists of perinatal care stops.
Département d'anesthésie-réanimation, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, BP 405, 92141 Clamart, France. dan.benhamou@bct.ap-hop-paris.fr
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D000328:Adult; D000773:Anesthesia, Obstetrical / Q000009:adverse effects; D000776:Anesthesiology / Q000331:legislation & jurisprudence* / Q000592:standards; D005260:Female; D005602:France; D006801:Humans; D009774:Obstetrics / Q000331:legislation & jurisprudence* / Q000592:standards; D036801:Parturition; D018743:Perinatal Care / Q000331:legislation & jurisprudence* / Q000592:standards; D011247:Pregnancy; D012041:Regional Medical Programs