Anesthesiologists’ practices for late termination of pregnancy: a French national survey

BackgroundApproximately 6600 cases of medical termination of pregnancy are performed in France annually, of which 78% are performed during the second or third trimester of pregnancy. There are few data and no recommendations regarding anesthesia and analgesia for these late terminations. The aims of this study were to determine the role of anesthesiologists and analgesia and anesthesia practices used for late terminations in France.MethodsAn electronic mailing survey was sent to all obstetric anesthesia teams working in hospitals with a prenatal diagnosis center in France. The same survey was also sent to a sample of obstetric anesthesia teams working in hospitals near Paris without a prenatal diagnosis center.ResultsThe response rate was 96% (45/47) for those with and 85% (23/27) for those without a prenatal diagnosis centre. Anesthesiologists at units with prenatal diagnosis participate on a regular or frequent basis on multidisciplinary prenatal committees in 36% of responding centers and are involved in 69% of centers in case of maternal health problems. Epidural or more rarely combined spinal–epidural analgesia is performed in more than 90% of cases. The block is performed after fetocide in 22% of centers and after the start of labor in 38% of centers. Sedation or general anesthesia is used at delivery in every case or at patient request in 2% and 60% of centers, respectively. Minor differences were found when comparing practices of high-volume centers with prenatal diagnosis and small volume centers without.ConclusionsFrench anesthesiologists do not participate routinely in the decision and planning of all late terminations. Overall, very similar analgesic and anesthetic practices are observed in high- and low- volume centers, with epidural techniques being the most common.