European Journal of Anaesthesiology最新文献

Neuraxial labour analgesia is considered the 'gold-standard' technique for the provision of analgesia during vaginal birth. Recently, there has been growing interest in the potential impacts of labour epidural analgesia beyond pain relief. One particular concern is its association with the development of maternal fever, so-called epidural-related maternal fever (ERMF). Hyperthermia during labour is a significant clinical concern, as it can impact both maternal and neonatal outcomes. This narrative review explores the association between epidural analgesia and maternal fever, outlines its suggested pathophysiological mechanisms, examines its potential implications and considers the management of neuraxial analgesia in the context of existing maternal fever. The two main theories explaining the development of ERMF are the sterile inflammation hypothesis, and the altered thermoregulation hypothesis. Patient characteristics, features of pregnancy and labour, midwifery and/or obstetric interventions and epidural-related factors can all contribute to an increased risk of developing ERMF. Although these factors may be manipulated to reduce ERMF incidence, there is no clear evidence that supports the recommendation of any intervention to prevent ERMF development. The associated detrimental effects of maternal fever on the woman, foetus, and newborn are highlighted, although many of these adverse outcomes have not been definitively established when ERMF has been the focus of study. There remains a significant need to further understand the pathophysiology, clinical significance, preventive strategies and treatment modalities of ERMF. It is crucial that future studies distinguish ERMF as a distinct category within maternal intrapartum fever.

Background: Postpartum depression impacts maternal health, child development, and overall family well being. General anaesthesia has been suggested as a potential risk factor.

Objective: To assess the association between anaesthetic methods and postpartum depression in women undergoing Caesarean section.

Design: Systematic review with meta-analysis.

Data sources: We searched PubMed, Embase and Web of Science through 16 April 2025, and included seven studies comprising 1 482 355 patients.

Eligibility criteria: Randomised controlled trials and cohort studies comparing postpartum depression outcomes in women undergoing Caesarean section with general anaesthesia versus non-general anaesthesia.

Results: Our results showed that general anaesthesia significantly increased the risk of both overall postpartum depression [odds ratio (OR) = 1.64, 95% confidence interval (CI), 1.23 to 2.19] and severe postpartum depression (OR = 1.41, 95% CI, 1.35 to 1.47). Subgroup analysis stratified by timing of postpartum depression diagnosis revealed an elevated risk within one-year postpartum (OR = 1.22, 95% CI, 1.02 to 1.46) and an even higher risk within seven-day postpartum (OR = 4.68, 95% CI, 1.21 to 18.09).

Conclusion: These findings highlight the importance of anaesthetic choices for Caesarean section and suggest that minimising general anaesthesia exposure may optimise both physical and mental health outcomes.

Postpartum haemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. While coagulation disorders are seldom the primary cause of PPH and are rare early in PPH, the incidence of coagulation abnormalities increases when blood loss escalates. Acute obstetric coagulopathy (AOC), with an incidence of one in 1000 deliveries, has emerged as a distinct coagulopathy in PPH, highlighting the need for timely coagulation testing and intervention. This narrative review examines the current evidence on the use of visco-elastic haemostatic assays (VHAs) to guide treatment in PPH, and further explores the prophylactic and therapeutic roles of fibrinogen and tranexamic acid (TXA). VHAs have shown potential in PPH management, with large prospective and retrospective cohort studies demonstrating reductions in transfusions and transfusion-related complications. However, these findings have not been consistently replicated, possibly due to variations in study design and statistical power. This review explores the benefits and limitations of VHAs in the context of PPH management. Until large, well designed studies suggest otherwise, women with PPH might benefit from access to VHAs, given their potential to improve clinical outcomes in large cohorts without evidence of associated harm. Fibrinogen replacement is essential in PPH management. VHAs have been shown to be as effective as the Clauss fibrinogen assay in guiding fibrinogen substitution during PPH. Recent updates to ROTEM Sigma cartridges have led to new FIBTEM A5 thresholds, with the Obstetric Bleeding Strategy (OBS) group of Wales proposing a FIBTEM A5 of 8 mm or less as the new trigger for fibrinogen replacement in PPH. Fibrinogen concentrate offers advantages over cryoprecipitate and may be preferred when both are available. Effective fibrinogen substitution not only corrects VHA results but also helps to control bleeding. TXA is a cornerstone in the treatment of PPH and should be administered promptly at a dose of 1 g as soon as PPH is diagnosed, regardless of VHA results, and always within three hours of onset. A second dose may be given if bleeding persists or recurs. However, high-quality randomised trials have consistently shown no benefit from prophylactic TXA in low-risk caesarean section or in vaginal births across all risk groups. Data on the prophylactic use of TXA in high-risk caesarean section are limited and its use in these cases should be based on clinical judgement and individual risk assessment.