Statement on Antenatal Anesthesiology Consultation

Developed by: Committee on Obstetric Anesthesia
Original Approval: October 15, 2025

Rationale & Benefits: 

The United States (U.S.) has the highest maternal mortality rate among high-income countries.^1-4 More than 80 percent of pregnancy-related deaths may have been prevented with timely access to high-quality care.⁴ Antenatal anesthesiology consultation during pregnancy for individuals with complex comorbidities or those at increased risk of significant peripartum complications⁵ helps improve outcomes with the goal of decreased severe maternal morbidity and mortality.⁶ This statement provides guidance for antenatal anesthesiology consultations. 

Indications for Consultation: See Table 1.

Consultation Structure:

• In-person v. Telehealth Consultations: High-risk obstetric anesthesiology consultations have traditionally been conducted in person but expanded telemedicine use in obstetric care has improved patient care accessibility. Factors influencing the choice between in-person and telemedicine include patient medical complexity, geographic location, technology access, and availability of institutional resources.^7-9 Timing of consultations should ensure timely patient evaluation and care.¹⁰
• Staffing: Large variability in staffing models for antenatal consultations exist.¹⁰ Physician anesthesiologists providing consultations should ideally have experience in high-risk obstetric anesthesia care. Involvement of other anesthesia care team members in high-risk obstetric anesthesiology consultations depends on institutional structure, practice regulations and patient acuity.

Financial Considerations:

• Billing: Anesthesiology antenatal consultations may be eligible for payment for services. Obstetric patients with complex co-morbidities may have medical necessity for ongoing management throughout the antenatal and labor and delivery periods that is separate and distinct from the routine pre-anesthesia assessment to determine an individualized anesthetic management plan.¹¹ Consultation with your billing department ensures compliance with documentation and CPT coding.
• Health System Financial Benefits: Proactive management of risk factors can optimize clinical status, prevent case delays and minimize complications^12-13 leading to reduced length of stay, readmissions, improved hospital resource utilization and cost efficiency, thus reducing hospital costs. Multidisciplinary care coordination and a patient-centered approach can improve patient experience and outcomes including maternal morbidity and mortality as well as racial and ethnic disparities in care.^6,14 Telemedicine consultations have demonstrated improved patient satisfaction, reduced cost and time savings.^15-16 
• Hospitals, payors and health care systems should support Anesthesiology antenatal consultations.¹⁷

Conclusion:

Antenatal anesthesiology consultations for indicated patients supports value-based care by improving maternal and neonatal outcomes, enhancing quality and reducing costs. ACOG recommends anesthesiology consultations for indicated obstetric patients.⁵ Hospitals, health systems and anesthesiologists may offer consultations with standardized, multidisciplinary pathways and stratify patients for in-person or telehealth visits. The cost of providing consultative services should be supported as consultation improves peripartum outcomes, reduces morbidity/mortality with substantial short and long-term financial and societal benefits. 

The ASA Committee on Obstetric Anesthesia has a more complete discussion of these recommendations as a committee resource.

Table 1: Indications for Antenatal Obstetric Anesthesiology Consultation 

References:

1. Donna L. Hoyert, PhD. Maternal Mortality Rates in the United States, 2023. NCHS Health E Stats. 2024.
2. Dorothy A. Fink, MD; Deborah Kilday, MSN; Zhun Cao, PhD; et al. Trends in Maternal Mortality and Severe Maternal Morbidity During Delivery-Related Hospitalizations in the United States, 2008 to 2021. JAMA Netw Open. Jun 1 2023;6(6):e2317641. doi:10.1001/jamanetworkopen.2023.17641
3. National Center for Chronic Disease Prevention and Health Promotion; Division of Reproductive Health. Severe Maternal Morbidity in the United States. Centers for Disease Control and Prevention. Updated February 29, 2024. Accessed March 6, 2025. https://www.cdc.gov/maternal-infant-health/php/severe-maternal-morbidity/. 
4. Pregnancy-Related Deaths: Data from maternal mortality review committees in 38 U.S. states, 2020. Maternal Mortality Prevention. Published May 28, 2024. https://www.cdc.gov/maternal-mortality/php/data-research/index.html. 
5. American College of O, Gynecologists' Committee on Practice B-O. ACOG Practice Bulletin No. 209: Obstetric Analgesia and Anesthesia. Obstet Gynecol. Mar 2019;133(3):e208-e225. doi:10.1097/AOG.0000000000003132
6. Statement on Anesthesiologists' Role in Reducing Maternal Mortality and Severe Maternal Morbidity. ASA Committee on Obstetric Anesthesia 2022. www.asahq.org/standards-and-practice-parameters/statement-on-anesthesiologists-role-in-reducing-maternal-mortality-and-severe-maternal-morbidity. Accessed April 25, 2025. 
7. Shirley S. Duarte, MD; Truc-Anh T. Nguyen, MD; Colleen Koch, MD; Kayode Williams, MD, MBA, FFARCSI; Jamie D. Murphy, MD. Remote Obstetric Anesthesia: Leveraging Telemedicine to Improve Fetal and Maternal Outcomes. Telemed J E Health. Aug 2020;26(8):967-972. doi:10.1089/tmj.2019.0174
8. Aleha Aziz, MD; Noelia Zork, MD; Janice J. Aubey, MD; et al. Telehealth for High-Risk Pregnancies in the Setting of the COVID-19 Pandemic. Am J Perinatol. Jun 2020;37(8):800-808. doi:10.1055/s-0040-1712121
9. Jorge A. Galvez, MD; Mohamed A. Rehman, MD. Telemedicine in anesthesia: an update. Curr Opin Anaesthesiol. Aug 2011;24(4):459-62. doi:10.1097/ACO.0b013e328348717b
10. Alexander J. Butwick, MBBS, MS;  Mohamed Tiouririne, Md. Evaluation of high-risk obstetric patients: a survey of US academic centers. J Clin Anesth. Sep 2016;33:460-8. doi:10.1016/j.jclinane.2016.04.005
11. Distinguishing Between a Pre-Anesthesia Evaluation and a Separately Reportable Evaluation and Management Service. ASA Committee on Economics 2023. https://www.asahq.org/quality-and-practice-management/managing-your-practice/timely-topics-in-payment-and-practice-management/distinguishing-between-a-pre-anesthesia-evaluation-and-a-separately-reportable-evaluation-and-management-service. Accessed April 25, 2025. 
12. Jake S. Engel, MD; WeiweiBeckerleg, MD, Duminda N. Wijeysundera, MD, PhD; et al. Association of preoperative anaesthesia consultation prior to elective noncardiac surgery with patient and health system outcomes: a population-based study. Br J Anaesth. Nov 2023;131(5):937-946. doi:10.1016/j.bja.2023.07.025
13. Eirunn Wallevik Kristoffersen, PhD; Anne Opsal, PhD; Tor Oddbjørn Tveit, PhD; Rigmor C Berg, PhD; Mariann Fossum, RN, MSc, PhD. Effectiveness of pre-anaesthetic assessment clinic: a systematic review of randomised and non-randomised prospective controlled studies. BMJ Open. May 11 2022;12(5):e054206. doi:10.1136/bmjopen-2021-054206
14. Statement on Reducing Maternal Peripartum Racial and Ethnic Disparities in Anesthesia Care. Committee on Obstetric Anesthesia 2021. https://www.asahq.org/standards-and-practice-parameters/statement-on-reducing-maternal-peripartum-racial-and-ethnic-disparities-in-anesthesia-care. Accessed April 25, 2025. 
15. Amber  L. O'Connor; Artem Shmelev, MD; Abigale Shettig, MD; et al. Assessing Patient-Reported Experiences for In-Person and Telemedicine-Based Preoperative Evaluations. Telemed J E Health. Feb 2024;30(2):472-479. doi:10.1089/tmj.2023.0089
16. Jose' Luis Garcia Martinez, MD, PhD; Miguel Ángel Morales Coca, MD, MSc, PhD;  Marta Del Olmo Rodriguez, PhD; et al. Effects of Virtually Led Value-Based Preoperative Assessment on Safety, Efficiency, and Patient and Professional Satisfaction. J Clin Med. Apr 29 2025;14(9)doi:10.3390/jcm14093093
17. ASA Statement on Economic Credentialing and Contracting, 2024, https://www.asahq.org/standards-and-practice-parameters/statement-on-economic-credentialing-and-contracting