International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2002
Trends in obstetric anaesthesia and analgesia over a ten year period in the University Malaya Medical Centre, Kuala Lumpur.
Available data for obstetric care in the University Malaya Medical Centre, Kuala Lumpur from 1987 to 1999 were reviewed. Despite incomplete data, we were able to determine fairly well the practice of obstetric anaesthesia and analgesia in the unit, and the changes over the years. ⋯ By 1999, regional anaesthesia had become the most common method of anaesthesia administered in both elective (14.3% epidural and 63.5% spinal) and emergency (30.2% epidural and 42.6% spinal) caesarean sections. The percentage of patients delivering vaginally who received epidural analgesia appeared to have stabilised at about 8 to 9% in the last few years, with a gradual decline in the total instrumental delivery rate from a high of about 12% to the pre-epidural rate of 7%.
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It has always been recognised that the practice of medicine requires an ethical base. This ethical base also provides a backbone for a legal framework. Until recently paternalism was the accepted norm in the physician-patient relationship. ⋯ Whether labouring women have capacity is discussed. There are times when patients are not able to act autonomously and the roles of advance directives (which can include birth plans) and substitute decision makers become important. The application of ethical practice to research in obstetric anaesthesia is considered.