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Obstetric Section 1998 Annual Report
Submitted by Dr. Roanne Preston, Chair

The Obstetric Section is now a very active Section outside of its activities at the Annual Meeting of the CAS. However, the central point of its activities remain the Annual Meeting.

In 1998, the Section hosted its luncheon on Monday, June 15 in Toronto, Dr. Stephen Halpern was the local host. Astra was the luncheon sponsor, there were 61 lunch attendees. Dr. Mark Norris from St. Louis and Dr. Roanne Preston from Ottawa debated the issue of what parturients should be allowed to take orally when in active labour. There was a lively discussion following the presentations, and perhaps a few minds were changed.

Unfortunately, the CAS evaluation forms did not reflect the very positive input the executive received following the luncheon, the section plans to do its own questionnaire in 1999 in order to give luncheon participants the opportunity to make suggestions for future topics.

The Section also organized a clinical forum on Emergencies in Obstetric Anesthesia. Dr. Barbara Leighton spoke on management of fetal distress, Dr. Ted Crosby on non-obstetric surgery during pregnancy, and Dr. Dave Campbell on management of the airway in obstetric anesthesia. Obstetric Section members also held two case discussions: Dr. Sharon Davies on amniotic fluid embolism, and Dr. Roanne Preston on Pulmonary Hypertension in pregnancy.

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The 1998 Business Meeting was held in the morning of June 15, there were 13 attendees. There were minor changes to the Section Executive made: Dr. Robert Nunn has become the Secretary of the Section, and Dr. Dave Campbell the Vice-Chair. Dr. Roanne Preston remains the Chair. Dr. Stephen Halpern has stepped down as the Section’s Scientific Affairs representative, replaced by Dr. Campbell.

Many topics were discussed, of which the highlights are as follows:

1. The financial report is appended. For the fiscal periods ending August 31, 1997 and August 31, 1998 the Obstetric section has broken even, in contrast to previous years’ positive financial balances. However, the section still has approximately $8000 in its account. Expenses over these two years have increased because the section sponsored Dr. Terrance Breen’s Obstetric Anesthesia Practice Questionnaire over 1997-98, as well as taking on a new expense of the section website.
   
2. Members of the Obstetric Section has been asked by the Committee on Standards of Practice to form a subcommittee to study creation of Obstetric anesthesia guidelines. Dr.Breen was chair of this committee, Dr.’s Campbell and Smedstad the other members. The committee created consensus and evidence based "Obstetric Regional Analgesia Practice Guidelines", which were accepted by the Committee on Standards of Practice in November 1998 and have been forwarded to the CAS executive. These guidelines will be reviewed every 3 years.
   
3. Dr. Roanne Preston has represented the CAS in the Core Group rewriting the national Family-Centred Maternal and Newborn Care Guidelines. This project is finally complete, and in the hands of the final editors. This is the first time that the specialty of Anesthesiology has been represented in creating these guidelines. Dr. Preston contributed as a writer to the section on labour analgesia.
   
4. Intra-operative fetal heart rate monitoring for non-obstetric surgery was a large issue addressed by the section in 1997-98. The issue has been resolved with the SOGC, with a recommendation for a co-operative team approach in all cases. Use of such monitoring should be available, but not required. Given that there is no evidence in the literature to either support or refute use of such monitoring, there will be no formal guidelines developed.
   
5. Dr. Terrance Breen will be the local host for the Obstetric Section in Calgary 1999. The luncheon speakers will be Dr. Breen discussing ambulation in labour, and Dr. Elizabeth Peter discussing analgesia after delivery. The section will also be holding an industry/section sponsored symposium on the Sunday of the meeting. The sponsor is Astra. The topics is Obstetric Anesthesia into the 21^st Century. Dr. Halpern will speak about epidural catheters and test doses, Dr. Preston will address spinal needles and CSE techniques, Dr. Nunn will talk about maintenance of labour analgesia: CEA or PCEA, and Dr. Campbell will discuss Ropivacaine for labour analgesia. Dr. Alison Macarthur has been invited by the CAS to be a refresher course lecturer in 1999, her topic will be: Anesthesia for the high-risk obstetric patient.
   
6. There has been a longstanding conflict with the Obstetric Section’s business meeting and other CAS events such as the Scientific Affairs Committee meeting, or obstetric case discussions/forums. In light of this, the Section has decided to hold future business meetings on Sunday morning at 7:30 am, so members will be able to attend all Obstetric Section events.

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Other areas in which the Obstetric Section has been active include the Canadian Airway Focus Group created and chaired by Dr.Ted Crosby. This group included Dr. Joanne Douglas, Dr. Holly Muir, and Dr.Roanne Preston who contributed the guidelines on management of the obstetric airway. CAFG produced the final document in 1998, and it was published in the Canadian Journal in August 1998.

The Obstetric Section has had its own website since July 1997. It is run by Dr. Roanne Preston, and is located at www.obanaesthesia.org.   The website is used for contact information for the section, meeting announcements, publication of Dr. Douglas’ quarterly newsletter, and an issues page looking at current topics in obstetric anesthesia. The section covers the financial cost of the website.

Finally, Dr. Roanne Preston met with the executive of the Society of Obstetricians and Gynecologists of Canada in November 1998, at their request. Dr. Preston reported to the CAS on the results of the meeting. Their was a good response to developing a more co-operative approach to any new guidelines that involve both specialities. The obstetric section was requested by the SOGC to look at some of their present guidelines for modification. This will be started in 1999.

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The Obstetric Section of the CAS is currently a very active section within the CAS, and no longer is merely focussed on the annual meeting. We hope to continue to be actively involved in the evolution of obstetric anesthesia in Canada into the 21^st century.

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