LETTERS TO THE EDITOR
First issue of Obstetric Medicine It was with excitement that I read Volume 1 Number 1 of Obstetric Medicine as such a publication is extremely important in highlighting research and clinical practice in obstetric medicine. Unfortunately, however, a key group of essential clinicians failed to receive a significant mention – the anaesthetists.1 Anaesthetists deal daily in a multidisciplinary context with both healthy pregnant women and with critically ill pregnant women.2 Anaesthesia facilitates the safe delivery of women as is highlighted in many instances in the latest Confidential Enquiry into Maternal and Child Health.3 Anaesthetists have acute resuscitation skills, provide life-saving interventions in women with obstetric haemorrhage and manage women with preeclampsia, cardiac disease, morbid obesity, mental illness and many other co-morbidities in the peripartum period. Anaesthetists provide essential analgesia during vaginal birth, and anaesthesia in the elective and emergency operative settings for pregnant women. It is also unfortunate that the article on preeclampsia information failed to consider the anaesthetist as part of the multidisciplinary team.4,5 Issues surrounding analgesia for vaginal birth and anaesthesia for caesarean birth are important to almost all women having babies, and in particular to women with concurrent disease who are often concerned that their co-morbidity may effect analgesia or anaesthesia. As it is the anaesthetist who manages the haemodynamics, airway and analgesia in these critically unwell women, such an omission is disturbing as the anaesthetist’s presence facilitates quality, safety, lessens anxiety and reduces morbidity and mortality. The presence of the anaesthetist also enables consumer choice and what can and cannot be achieved by the multidisciplinary team. All members of the multidisciplinary team are important and communication, handover, informed consent and education are fundamental for the ongoing safe birthing of women. The anaesthetist is a key member of this team and must not be forgotten.
REFERENCES 1 Lowe S, Nelson-Piercy C, Rosene-Montella K. Welcome to Obstetric Medicine: the Medicine of Pregnancy. Obstet Med 2008;1:1 2 Guise JM, Segel S. Teamwork in obstetric critical care. Best Pract Res Clin Obstet Gynaecol 2008;22:937 –51 3 Lewis G. The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers’ Lives: Reviewing Maternal Deaths to Make Motherhood Safer – 2003 –2005. London: CEMACH, 2007 4 Sauve´ N, Powrie RO, Larson L, et al. The impact of an educational pamphlet on knowledge and anxiety in women with preeclampsia. Obstet Med 2008;1:11 –17 5 Dyer RA, Piercy JL, Reed AR. The role of the anaesthetist in the management of the pre-eclamptic patient. Curr Opin Anaesthesiol 2007;20:168 –74
Reply to: First issue of Obstetric Medicine We thank Dr Dennis for her letter highlighting the importance of anaesthetists in the multidisciplinary team caring for pregnant women with medical problems; a sentiment with which we (and we are sure most of our readers) all agree. Furthermore, we would stress the importance of obstetric anaesthetists in particular, rather than anaesthetists in general, as they have a unique knowledge and expertise of normal and abnormal physiology and pharmacology in pregnant and puerperal women. We are confident that you will find many references to the role of anaesthetists in the care of pregnant women with medical problems in future review articles and original papers published in Obstetric Medicine. However, we make no apologies for failing to mention anaesthetists in our first editorial. The field of obstetric anaesthesia has had its own journal, The International Journal of Obstetric Anaesthesia for over 15 years. Obstetric Medicine is the first and only medical journal whose remit is limited to medical problems in pregnancy. There are fewer (by several orders of magnitude) obstetric physicians in the world than obstetric anaesthetists and their role is perhaps not so wellrecognized. Allow us a little space to indulge the important milestone of a dedicated journal for our small specialty!
Dr Alicia Dennis
Catherine Nelson-Piercy, Sandra Lowe and Karen Rosene-Montella
Mercy Hospital for Women, 163 Studley Road, Heidelberg Vic. 3084, Australia Email: [email protected] DOI: 10.1258/om.2008.080048
Correspondence to: Catherine Nelson-Piercy Email: [email protected] DOI: 10.1258/om.2008.081000
Obstetric Medicine 2009; 2: 44
First issue of Obstetric Medicine It was with excitement that I read Volume 1 Number 1 of Obstetric Medicine as such a publication is extremely important in highlighting research and clinical practice in obstetric medicine. Unfortunately, however, a key group of essential clinicians failed to receive a significant mention – the anaesthetists.1 Anaesthetists deal daily in a multidisciplinary context with both healthy pregnant women and with critically ill pregnant women.2 Anaesthesia facilitates the safe delivery of women as is highlighted in many instances in the latest Confidential Enquiry into Maternal and Child Health.3 Anaesthetists have acute resuscitation skills, provide life-saving interventions in women with obstetric haemorrhage and manage women with preeclampsia, cardiac disease, morbid obesity, mental illness and many other co-morbidities in the peripartum period. Anaesthetists provide essential analgesia during vaginal birth, and anaesthesia in the elective and emergency operative settings for pregnant women. It is also unfortunate that the article on preeclampsia information failed to consider the anaesthetist as part of the multidisciplinary team.4,5 Issues surrounding analgesia for vaginal birth and anaesthesia for caesarean birth are important to almost all women having babies, and in particular to women with concurrent disease who are often concerned that their co-morbidity may effect analgesia or anaesthesia. As it is the anaesthetist who manages the haemodynamics, airway and analgesia in these critically unwell women, such an omission is disturbing as the anaesthetist’s presence facilitates quality, safety, lessens anxiety and reduces morbidity and mortality. The presence of the anaesthetist also enables consumer choice and what can and cannot be achieved by the multidisciplinary team. All members of the multidisciplinary team are important and communication, handover, informed consent and education are fundamental for the ongoing safe birthing of women. The anaesthetist is a key member of this team and must not be forgotten.
REFERENCES 1 Lowe S, Nelson-Piercy C, Rosene-Montella K. Welcome to Obstetric Medicine: the Medicine of Pregnancy. Obstet Med 2008;1:1 2 Guise JM, Segel S. Teamwork in obstetric critical care. Best Pract Res Clin Obstet Gynaecol 2008;22:937 –51 3 Lewis G. The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers’ Lives: Reviewing Maternal Deaths to Make Motherhood Safer – 2003 –2005. London: CEMACH, 2007 4 Sauve´ N, Powrie RO, Larson L, et al. The impact of an educational pamphlet on knowledge and anxiety in women with preeclampsia. Obstet Med 2008;1:11 –17 5 Dyer RA, Piercy JL, Reed AR. The role of the anaesthetist in the management of the pre-eclamptic patient. Curr Opin Anaesthesiol 2007;20:168 –74
Reply to: First issue of Obstetric Medicine We thank Dr Dennis for her letter highlighting the importance of anaesthetists in the multidisciplinary team caring for pregnant women with medical problems; a sentiment with which we (and we are sure most of our readers) all agree. Furthermore, we would stress the importance of obstetric anaesthetists in particular, rather than anaesthetists in general, as they have a unique knowledge and expertise of normal and abnormal physiology and pharmacology in pregnant and puerperal women. We are confident that you will find many references to the role of anaesthetists in the care of pregnant women with medical problems in future review articles and original papers published in Obstetric Medicine. However, we make no apologies for failing to mention anaesthetists in our first editorial. The field of obstetric anaesthesia has had its own journal, The International Journal of Obstetric Anaesthesia for over 15 years. Obstetric Medicine is the first and only medical journal whose remit is limited to medical problems in pregnancy. There are fewer (by several orders of magnitude) obstetric physicians in the world than obstetric anaesthetists and their role is perhaps not so wellrecognized. Allow us a little space to indulge the important milestone of a dedicated journal for our small specialty!
Dr Alicia Dennis
Catherine Nelson-Piercy, Sandra Lowe and Karen Rosene-Montella
Mercy Hospital for Women, 163 Studley Road, Heidelberg Vic. 3084, Australia Email: [email protected] DOI: 10.1258/om.2008.080048
Correspondence to: Catherine Nelson-Piercy Email: [email protected] DOI: 10.1258/om.2008.081000
Obstetric Medicine 2009; 2: 44
