Pub Date : 2025-02-10DOI: 10.1016/j.ijoa.2025.104342
M. Schram , F. Uys , J. Purcell-Jones , C.L. Pfister
Pre-eclampsia is the second leading cause of maternal mortality worldwide, with over 99% of deaths occurring in low and middle income countries (LMICs). In South Africa, pre-eclampsia and obstetric haemorrhage are among the three primary causes of maternal mortality. These conditions pose significant challenges for even the most experienced healthcare providers with regular exposure to obstetric patients. Pre-eclampsia with severe features, in its most extreme form, can present with diastolic and systolic dysfunction and cardiogenic shock. This, in combination with a hypocoagulable state and hypovolemic shock from postpartum haemorrhage (PPH), can present a resuscitation conundrum for the anaesthetist. Point-of-care-ultrasonography (POCUS) is a useful tool to guide management of these complicated obstetric resuscitations.
{"title":"POCUS and pre-eclampsia: bedside echocardiography to guide resuscitation in cardiogenic shock with pre-eclampsia with severe features – a case report from a low and middle income country","authors":"M. Schram , F. Uys , J. Purcell-Jones , C.L. Pfister","doi":"10.1016/j.ijoa.2025.104342","DOIUrl":"10.1016/j.ijoa.2025.104342","url":null,"abstract":"<div><div>Pre-eclampsia is the second leading cause of maternal mortality worldwide, with over 99% of deaths occurring in low and middle income countries (LMICs). In South Africa, pre-eclampsia and obstetric haemorrhage are among the three primary causes of maternal mortality. These conditions pose significant challenges for even the most experienced healthcare providers with regular exposure to obstetric patients. Pre-eclampsia with severe features, in its most extreme form, can present with diastolic and systolic dysfunction and cardiogenic shock. This, in combination with a hypocoagulable state and hypovolemic shock from postpartum haemorrhage (PPH), can present a resuscitation conundrum for the anaesthetist. Point-of-care-ultrasonography (POCUS) is a useful tool to guide management of these complicated obstetric resuscitations.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104342"},"PeriodicalIF":2.6,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ijoa.2024.104311
Yair Binyamin, Sharon Orbach-Zinger, Michael Heesen
{"title":"Beyond the puncture: new guidelines for intrathecal catheter management in obstetric anesthesia","authors":"Yair Binyamin, Sharon Orbach-Zinger, Michael Heesen","doi":"10.1016/j.ijoa.2024.104311","DOIUrl":"10.1016/j.ijoa.2024.104311","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104311"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ijoa.2024.104317
D. Lee, M. Brown, J. Hammond, M. Zakowski
Introduction
Over 90% of pregnant women and 76% expectant fathers search for pregnancy health information. We examined readability, accuracy and quality of answers to common obstetric anesthesia questions from the popular generative artificial intelligence (AI) chatbots ChatGPT and Bard.
Methods
Twenty questions for generative AI chatbots were derived from frequently asked questions based on professional society, hospital and consumer websites. ChatGPT and Bard were queried in November 2023. Answers were graded for accuracy by four obstetric anesthesiologists. Quality was measured using Patient Education Materials Assessment Tool for Print (PEMAT). Readability was measured using six readability indices. Accuracy, quality and readability were compared using independent t-test.
Results
Bard readability scores were high school level, significantly easier than ChatGPT’s college level by all scoring metrics (P <0.001). Bard had significantly longer answers (P <0.001), yet with similar accuracy of Bard (85 % ± 10) and ChatGPT (87 % ± 14) (P = 0.5). PEMAT understandability scores were no statistically significantly different (P = 0.06). Actionability by PEMAT scores for Bard was significantly higher (22% vs. 9%) than ChatGPT (P = 0.007)
Conclusion
Answers to questions about “labor epidurals” should be accurate, high quality, and easy to read. Bard at high school reading level, was well above the goal 4th to 6th grade level suggested for patient materials. Consumers, health care providers, hospitals and governmental agencies should be aware of the quality of information generated by chatbots. Chatbots should meet the standards for readability and understandability of health-related questions, to aid public understanding and enhance shared decision-making.
{"title":"Readability, quality and accuracy of generative artificial intelligence chatbots for commonly asked questions about labor epidurals: a comparison of ChatGPT and Bard","authors":"D. Lee, M. Brown, J. Hammond, M. Zakowski","doi":"10.1016/j.ijoa.2024.104317","DOIUrl":"10.1016/j.ijoa.2024.104317","url":null,"abstract":"<div><h3>Introduction</h3><div>Over 90% of pregnant women and 76% expectant fathers search for pregnancy health information. We examined readability, accuracy and quality of answers to common obstetric anesthesia questions from the popular generative artificial intelligence (AI) chatbots ChatGPT and Bard.</div></div><div><h3>Methods</h3><div>Twenty questions for generative AI chatbots were derived from frequently asked questions based on professional society, hospital and consumer websites. ChatGPT and Bard were queried in November 2023. Answers were graded for accuracy by four obstetric anesthesiologists. Quality was measured using Patient Education Materials Assessment Tool for Print (PEMAT). Readability was measured using six readability indices. Accuracy, quality and readability were compared using independent <em>t</em>-test.</div></div><div><h3>Results</h3><div>Bard readability scores were high school level, significantly easier than ChatGPT’s college level by all scoring metrics (<em>P</em> <0.001). Bard had significantly longer answers (<em>P</em> <0.001), yet with similar accuracy of Bard (85 % ± 10) and ChatGPT (87 % ± 14) (<em>P</em> = 0.5). PEMAT understandability scores were no statistically significantly different (<em>P</em> = 0.06). Actionability by PEMAT scores for Bard was significantly higher (22% vs. 9%) than ChatGPT (<em>P</em> = 0.007)</div></div><div><h3>Conclusion</h3><div>Answers to questions about “labor epidurals” should be accurate, high quality, and easy to read. Bard at high school reading level, was well above the goal 4<sup>th</sup> to 6<sup>th</sup> grade level suggested for patient materials. Consumers, health care providers, hospitals and governmental agencies should be aware of the quality of information generated by chatbots. Chatbots should meet the standards for readability and understandability of health-related questions, to aid public understanding and enhance shared decision-making.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104317"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ijoa.2025.104329
Raneen Abu Shqara , Gabriela Goldinfeld , Sari Nahir Biderman , Tatiana Sher Brodsky , Asal Darwish , Nadir Ganem , Lior Lowenstein , Maya Frank Wolf
Background
To evaluate pregnant women’s intentions to deliver with labor epidural analgesia (LEA) and identify factors influencing decision-making in a diverse population in northern Israel.
Methods
A cross-sectional survey was conducted at Galilee Medical Center from February to July 2024. Women completed pre- and post-labor questionnaires assessing demographics, religiosity, prior experience, prenatal education, attitude towards LEA, reasons for not intending to deliver with and actual LEA use. Statistical analysis included multivariate logistic regression.
Results
The LEA rate among participants was 83.5% (380/455) (83.5%); 257 (56.5%) had indented to deliver with. Among those not intending to deliver with LEA, 66.7% (132/198) eventually delivered with. There were 297 (65.3%) Arab and 158 (34.7%) Jewish women; 180 (39.6%) identified as Muslim, 158 (34.7%) Jewish, 92 (20.2%) Druze, and 25 (5.5%) Christian. Factors associated with intention to deliver with LEA were nulliparity (P =0.024), childbirth preparation course (P =0.002), internet as source of information (P =0.016), and previous delivery with LEA (P <0.001). Factors associated with not intending to deliver with but ultimately delivering with LEA were nulliparity (P =0.033), partner presence (P <0.001), labor induction (P =0.044), and previous delivery with LEA (P <0.001).
Conclusion
Attitudes toward LEA are shaped by culture, knowledge, prior experiences, and social support. In our cohort, the most important factors for delivering with LEA when not intending to were previous delivery with LEA and partner presence. Factors associated with not delivering with LEA were preference for natural childbirth and fear of LEA-associated side effects. Promoting evidence-based information through language-adapted platforms can further improve informed decision-making about LEA.
{"title":"Factors affecting womens’ attitude towards labor epidural analgesia in a culturally diverse population: a prospective patient-reported outcome study","authors":"Raneen Abu Shqara , Gabriela Goldinfeld , Sari Nahir Biderman , Tatiana Sher Brodsky , Asal Darwish , Nadir Ganem , Lior Lowenstein , Maya Frank Wolf","doi":"10.1016/j.ijoa.2025.104329","DOIUrl":"10.1016/j.ijoa.2025.104329","url":null,"abstract":"<div><h3>Background</h3><div>To evaluate pregnant women’s intentions to deliver with labor epidural analgesia (LEA) and identify factors influencing decision-making in a diverse population in northern Israel.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted at Galilee Medical Center from February to July 2024. Women completed pre- and post-labor questionnaires assessing demographics, religiosity, prior experience, prenatal education, attitude towards LEA, reasons for not intending to deliver with and actual LEA use. Statistical analysis included multivariate logistic regression.</div></div><div><h3>Results</h3><div>The LEA rate among participants was 83.5% (380/455) (83.5%); 257 (56.5%) had indented to deliver with. Among those not intending to deliver with LEA, 66.7% (132/198) eventually delivered with. There were 297 (65.3%) Arab and 158 (34.7%) Jewish women; 180 (39.6%) identified as Muslim, 158 (34.7%) Jewish, 92 (20.2%) Druze, and 25 (5.5%) Christian. Factors associated with intention to deliver with LEA were nulliparity (<em>P</em> =0.024), childbirth preparation course (<em>P</em> =0.002), internet as source of information (<em>P</em> =0.016), and previous delivery with LEA (<em>P</em> <0.001). Factors associated with not intending to deliver with but ultimately delivering with LEA were nulliparity (<em>P</em> =0.033), partner presence (<em>P</em> <0.001), labor induction (<em>P</em> =0.044), and previous delivery with LEA (<em>P</em> <0.001).</div></div><div><h3>Conclusion</h3><div>Attitudes toward LEA are shaped by culture, knowledge, prior experiences, and social support. In our cohort, the most important factors for delivering with LEA when not intending to were previous delivery with LEA and partner presence. Factors associated with not delivering with LEA were preference for natural childbirth and fear of LEA-associated side effects. Promoting evidence-based information through language-adapted platforms can further improve informed decision-making about LEA.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104329"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ijoa.2024.104327
J. Clifton , S. Woodward , S. Hardcastle , T. Ziga , A. Lewis , H. Ende , J. Bauchat
Background
Disparities in labor epidural analgesia (LEA) management could reduce maternal satisfaction and increase risk. We compared times from the first administration of breakthrough pain medication (top-up) to LEA replacement to evaluate disparities across race.
Methods
In this retrospective cohort study (01-01-2018 to 12-31-2022), all patients with LEA and maternal race/ethnicity of non-Hispanic White or Black were eligible. Patients with a scheduled cesarean delivery, previous back instrumentation, or maternal age < 18 were excluded. We used a Cox Proportional Hazards model to evaluate our primary outcome. Predefined top-up medications given ≥60 minutes from initial LEA placement and before replacement were valid. Any replacement ≥60 minutes from the initial LEA was valid. We also studied secondary outcomes incidence of epidural replacement and postoperative patient satisfaction.
Results
There were 11,168 total patients receiving LEA, with 479 (5.5%) replacements in White patients and 127 (5.0%) in Black patients. There were 387 (3.5%) LEAs with a top-up followed by replacement within 24 hours. After adjusting for confounders, no association was detected between race and LEA management (Hazard Ratio 0.82; 95% CI 0.63, 1.06; P = 0.13). We failed to detect an association between patient race and the incidence of replacement (P = 0.23). We found that race (P = 0.02) and LEA replacement (P < 0.001) were associated with increased odds of lower postpartum satisfaction.
Conclusions
We didn’t detect disparity in treatment at our institution with standardized LEA management protocols. However, Black women and those with LEA replacements were less satisfied. Future studies should evaluate the generalizability and explore interventions that improve patient satisfaction.
背景：分娩时硬膜外镇痛（LEA）管理的差异会降低产妇满意度，增加分娩风险。我们比较了从首次使用突破性止痛药（补充）到更换LEA的时间，以评估种族间的差异。方法：在这项回顾性队列研究中（2018年1月1日至2022年12月31日），所有LEA患者和母亲种族/民族为非西班牙裔白人或黑人。结果：共有11168例患者接受了LEA，其中白人患者为479例（5.5%），黑人患者为127例（5.0%）。有387例（3.5%）lea在24小时内充值并更换。调整混杂因素后，未发现种族与LEA管理之间存在关联(风险比0.82；95% ci 0.63, 1.06；p = 0.13)。我们未能发现患者种族与置换发生率之间的关联（P = 0.23）。我们发现种族（P = 0.02）和LEA替代(P)。结论：我们没有发现在我们机构采用标准化LEA管理方案的治疗存在差异。然而，黑人女性和接受LEA置换的女性则不太满意。未来的研究应评估其普遍性，并探索提高患者满意度的干预措施。
{"title":"Investigating disparity in labor epidural analgesia management in black vs. white women: a retrospective case-control study (2018–2022)","authors":"J. Clifton , S. Woodward , S. Hardcastle , T. Ziga , A. Lewis , H. Ende , J. Bauchat","doi":"10.1016/j.ijoa.2024.104327","DOIUrl":"10.1016/j.ijoa.2024.104327","url":null,"abstract":"<div><h3>Background</h3><div>Disparities in labor epidural analgesia (LEA) management could reduce maternal satisfaction and increase risk. We compared times from the first administration of breakthrough pain medication (top-up) to LEA replacement to evaluate disparities across race.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study (01-01-2018 to 12-31-2022), all patients with LEA and maternal race/ethnicity of non-Hispanic White or Black were eligible. Patients with a scheduled cesarean delivery, previous back instrumentation, or maternal age < 18 were excluded. We used a Cox Proportional Hazards model to evaluate our primary outcome. Predefined top-up medications given ≥60 minutes from initial LEA placement and before replacement were valid. Any replacement ≥60 minutes from the initial LEA was valid. We also studied secondary outcomes incidence of epidural replacement and postoperative patient satisfaction.</div></div><div><h3>Results</h3><div>There were 11,168 total patients receiving LEA, with 479 (5.5%) replacements in White patients and 127 (5.0%) in Black patients. There were 387 (3.5%) LEAs with a top-up followed by replacement within 24 hours. After adjusting for confounders, no association was detected between race and LEA management (Hazard Ratio 0.82; 95% CI 0.63, 1.06; <em>P</em> = 0.13). We failed to detect an association between patient race and the incidence of replacement (<em>P</em> = 0.23). We found that race (<em>P</em> = 0.02) and LEA replacement (<em>P</em> < 0.001) were associated with increased odds of lower postpartum satisfaction.</div></div><div><h3>Conclusions</h3><div>We didn’t detect disparity in treatment at our institution with standardized LEA management protocols. However, Black women and those with LEA replacements were less satisfied. Future studies should evaluate the generalizability and explore interventions that improve patient satisfaction.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104327"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ijoa.2025.104330
Ruth Landau
{"title":"Embracing change: 2025 priorities and new structure of the Editorial Board of the International Journal of Obstetric Anesthesia","authors":"Ruth Landau","doi":"10.1016/j.ijoa.2025.104330","DOIUrl":"10.1016/j.ijoa.2025.104330","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104330"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143038788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ijoa.2024.104299
S. Goto, Y. Suzuki, S. Kurokawa, Y. Nagasaka
Background
Arterial switch operation (ASO) for dextro-transposition of the great arteries was developed four decades ago, and women with ASO have reached childbearing age. Although over 40% of the pregnant women who received ASO gave birth via cesarean delivery, detailed information about anesthesia management has not been reported. This study aimed to evaluate anesthesia and perioperative outcomes in pregnant women with ASO undergoing cesarean delivery.
Methods
A retrospective chart review was conducted on pregnant women with a history of ASO with a cesarean delivery at Tokyo Women’s Medical University Hospital between January 1, 2015, and May 31, 2023. Obstetric and anesthetic management, as well as maternal outcomes, were analyzed.
Results
A total of 12 cesarean deliveries among 10 ASO patients were identified. The median maternal age at cesarean delivery was 29 years (range: 26–38) and median gestational age was 37 weeks and 1 day (33 weeks and 6 days – 37 weeks and 6 days). Two patients developed arrhythmia (paroxysmal supraventricular tachycardia, non-sustained ventricular tachycardia, and atrial tachyarrhythmia) during pregnancy. Five patients presented with moderate to severe valvular regurgitation, three of which worsened during pregnancy. All patients received neuraxial anesthesia for the cesarean delivery. Spinal induced hypotension occurred in four cases, which was immediately treated with vasopressors. No patient developed heart failure or arrhythmias postoperatively.
Conclusion
Neuraxial anesthesia for cesarean delivery in pregnant women with a history of ASO resulted in favorable maternal outcomes with no postoperative cardiac complications.
{"title":"Anesthesia management for cesarean delivery in patients with an arterial switch operation: a single center case series (2015–2023)","authors":"S. Goto, Y. Suzuki, S. Kurokawa, Y. Nagasaka","doi":"10.1016/j.ijoa.2024.104299","DOIUrl":"10.1016/j.ijoa.2024.104299","url":null,"abstract":"<div><h3>Background</h3><div>Arterial switch operation (ASO) for dextro-transposition of the great arteries was developed four decades ago, and women with ASO have reached childbearing age. Although over 40% of the pregnant women who received ASO gave birth via cesarean delivery, detailed information about anesthesia management has not been reported. This study aimed to evaluate anesthesia and perioperative outcomes in pregnant women with ASO undergoing cesarean delivery.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted on pregnant women with a history of ASO with a cesarean delivery at Tokyo Women’s Medical University Hospital between January 1, 2015, and May 31, 2023. Obstetric and anesthetic management, as well as maternal outcomes, were analyzed.</div></div><div><h3>Results</h3><div>A total of 12 cesarean deliveries among 10 ASO patients were identified. The median maternal age at cesarean delivery was 29 years (range: 26–38) and median gestational age was 37 weeks and 1 day (33 weeks and 6 days – 37 weeks and 6 days). Two patients developed arrhythmia (paroxysmal supraventricular tachycardia, non-sustained ventricular tachycardia, and atrial tachyarrhythmia) during pregnancy. Five patients presented with moderate to severe valvular regurgitation, three of which worsened during pregnancy. All patients received neuraxial anesthesia for the cesarean delivery. Spinal induced hypotension occurred in four cases, which was immediately treated with vasopressors. No patient developed heart failure or arrhythmias postoperatively.</div></div><div><h3>Conclusion</h3><div>Neuraxial anesthesia for cesarean delivery in pregnant women with a history of ASO resulted in favorable maternal outcomes with no postoperative cardiac complications.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104299"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ijoa.2024.104307
Yehuda Ginosar , Or Sandman , Aharon Tevet , Malka Boret , Riki Greenberger , Zipora Boim , Ibrahim Naffar , Esty Harpenas , Jacob Pe’er , Tali Bdolah-Abram , Ronit Calderon-Margalit , Hadas Ben-Eli , for the CHRISTMAS* study group
Background
Observational studies should not be used to infer causation as they are prone to confounding factors, selection bias, and reverse causality. Many observational studies of labor analgesia treated epidurals as an independent exposure and concluded that “epidurals” cause dystocia, despite multiple randomized controlled trials showing no effect. We highlight this problem using reductio ad absurdum. We explore whether people request reading glasses when their progressively increasing focal length equals or exceeds their fixed arm length.
Methods
We designed a cross-sectional retrospective and prospective observational study to assess whether there is an association between arm length and age when first requesting reading glasses in presbyopia. We evaluated individuals aged 38–55 receiving their first reading glasses for presbyopia (either currently or within the past year). We recorded age at first request for reading glasses, the refractive correction (additions) in each eye, and we measured arm length.
Results
Seventy subjects were included in the study. No association was found between arm length and the age at request for reading glasses or the severity of presbyopia at presentation.
Conclusions
Even if this observational study had demonstrated a strong correlation between age at request for reading glasses and arm length, it would have been absurd to conclude that spectacles somehow cause our arms to shrink. Similarly, women in obstructed labor with a narrow pelvis are more likely to request neuraxial labor analgesia, but “epidurals” do not make their pelvis shrink. Making far-reaching causal inferences based on retrospective or observational data is very shortsighted.
{"title":"On causal inferences from retrospective and observational studies and their implications for neuraxial labor analgesia: the CHRISTMAS* study","authors":"Yehuda Ginosar , Or Sandman , Aharon Tevet , Malka Boret , Riki Greenberger , Zipora Boim , Ibrahim Naffar , Esty Harpenas , Jacob Pe’er , Tali Bdolah-Abram , Ronit Calderon-Margalit , Hadas Ben-Eli , for the CHRISTMAS* study group","doi":"10.1016/j.ijoa.2024.104307","DOIUrl":"10.1016/j.ijoa.2024.104307","url":null,"abstract":"<div><h3>Background</h3><div>Observational studies should not be used to infer causation as they are prone to confounding factors, selection bias, and reverse causality. Many observational studies of labor analgesia treated epidurals as an independent exposure and concluded that “epidurals” cause dystocia, despite multiple randomized controlled trials showing no effect. We highlight this problem using <em>reductio ad absurdum.</em> We explore whether people request reading glasses when their progressively increasing focal length equals or exceeds their fixed arm length.</div></div><div><h3>Methods</h3><div>We designed a cross-sectional retrospective and prospective observational study to assess whether there is an association between arm length and age when first requesting reading glasses in presbyopia. We evaluated individuals aged 38–55 receiving their first reading glasses for presbyopia (either currently or within the past year). We recorded age at first request for reading glasses, the refractive correction (additions) in each eye, and we measured arm length.</div></div><div><h3>Results</h3><div>Seventy subjects were included in the study. No association was found between arm length and the age at request for reading glasses or the severity of presbyopia at presentation.</div></div><div><h3>Conclusions</h3><div>Even if this observational study had demonstrated a strong correlation between age at request for reading glasses and arm length, it would have been absurd to conclude that spectacles somehow cause our arms to shrink. Similarly, women in obstructed labor with a narrow pelvis are more likely to request neuraxial labor analgesia, but “epidurals” do not make their pelvis shrink. Making far-reaching causal inferences based on retrospective or observational data is very shortsighted.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"61 ","pages":"Article 104307"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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