Pub Date : 2026-01-12DOI: 10.1016/j.ijoa.2026.104850
S. Ayoub, N. Pate, J. Sheeran
Respecting patient autonomy can present complex challenges in obstetric anesthesia, particularly when a mother desires safe maternal-fetal care but is unable to cooperate due to psychological barriers. The Ulysses contract is a framework that allows patients to consent to treatment in advance if they are to lack decision making capacity later. This case illustrates a unique implementation of the Ulysses contract in an obstetric patient in which involvement of early multidisciplinary support was paramount to allow safe and timely medical care that aligned with the patient’s wishes.
{"title":"Implementation of the Ulysses contract in a patient with severe needle phobia: a case report","authors":"S. Ayoub, N. Pate, J. Sheeran","doi":"10.1016/j.ijoa.2026.104850","DOIUrl":"10.1016/j.ijoa.2026.104850","url":null,"abstract":"<div><div>Respecting patient autonomy can present complex challenges in obstetric anesthesia, particularly when a mother desires safe maternal-fetal care but is unable to cooperate due to psychological barriers. The Ulysses contract is a framework that allows patients to consent to treatment in advance if they are to lack decision making capacity later. This case illustrates a unique implementation of the Ulysses contract in an obstetric patient in which involvement of early multidisciplinary support was paramount to allow safe and timely medical care that aligned with the patient’s wishes.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"66 ","pages":"Article 104850"},"PeriodicalIF":2.3,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981471","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 : 2026-01-12DOI: 10.1016/j.ijoa.2026.104851
William Turner , Kat Butler , Nuala Coyle
Background
Transgender and gender-diverse individuals are increasingly accessing obstetric services, yet evidence relating to their intrapartum care remains limited. This study surveyed obstetric anaesthetists practising in the United Kingdom (UK) to explore experience, training, departmental policies, and perspectives on language and care.
Methods
An anonymous thirteen-question online survey was distributed to members of the Obstetric Anaesthetists’ Association (OAA) in June 2025. Quantitative responses were summarised descriptively, and free-text responses were reviewed by recurring topics.
Results
The response rate was low (13.7%) and a total of 262 responses were analysed. Most respondents were consultants, and nearly half had more than ten years’ experience. Formal training was uncommon, and almost half reported never providing intrapartum care to a transgender patient. Few reported departmental policies, and comfort levels varied. Most believed inclusive language improved care.
Conclusions
This survey of UK-based OAA members demonstrated gaps in experience, and systems support for transgender and gender-diverse intrapartum care, and lack of training in transgender obstetric anaesthesia care, alongside the importance of respectful, patient-centred communication.
{"title":"Intrapartum care for transgender and gender-diverse individuals: an Obstetric Anaesthetists Association (OAA) members’ perspective survey (2025)","authors":"William Turner , Kat Butler , Nuala Coyle","doi":"10.1016/j.ijoa.2026.104851","DOIUrl":"10.1016/j.ijoa.2026.104851","url":null,"abstract":"<div><h3>Background</h3><div>Transgender and gender-diverse individuals are increasingly accessing obstetric services, yet evidence relating to their intrapartum care remains limited. This study surveyed obstetric anaesthetists practising in the United Kingdom (UK) to explore experience, training, departmental policies, and perspectives on language and care.</div></div><div><h3>Methods</h3><div>An anonymous thirteen-question online survey was distributed to members of the Obstetric Anaesthetists’ Association (OAA) in June 2025. Quantitative responses were summarised descriptively, and free-text responses were reviewed by recurring topics.</div></div><div><h3>Results</h3><div>The response rate was low (13.7%) and a total of 262 responses were analysed. Most respondents were consultants, and nearly half had more than ten years’ experience. Formal training was uncommon, and almost half reported never providing intrapartum care to a transgender patient. Few reported departmental policies, and comfort levels varied. Most believed inclusive language improved care.</div></div><div><h3>Conclusions</h3><div>This survey of UK-based OAA members demonstrated gaps in experience, and systems support for transgender and gender-diverse intrapartum care, and lack of training in transgender obstetric anaesthesia care, alongside the importance of respectful, patient-centred communication.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"66 ","pages":"Article 104851"},"PeriodicalIF":2.3,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981470","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 : 2026-01-10DOI: 10.1016/j.ijoa.2026.104849
M. Balot, G. Echevarria, A. Lee, B. Mahoney
Background
Combined spinal epidural (CSE) and dural puncture epidural (DPE) procedures have become increasingly utilized for labor analgesia, though no standards exist on which spinal needle to use. It has been demonstrated that pencil-point needles reduce the rate of postdural puncture headaches; however, there is no consensus on the optimal size to minimize headache risk while maximizing analgesia.
Methods
A single-center retrospective cohort study was conducted of parturients receiving CSE or DPE for neuraxial labor analgesia between 2018 and 2023 to identify the postdural puncture headache rate with intended (but not unintended) dural puncture.
Results
A total of 10,459 CSE and DPE procedures were performed during the study period, with CSE most commonly performed (91%). For CSE, 27G needle was used in 69% of cases, and for DPE, 25G needle was used in nearly two-thirds of cases. Fifty-four patients (0.52%) experienced a postdural puncture headache (without evidence of unintended dural puncture with epidural needle). Postdural puncture headache occurred more frequently with 25G needles than with 27G needles (0.73% vs. 0.41%), corresponding to a risk ratio of 0.56 (95% CI 0.34–0.92; P=0.029)).
Conclusions
There was a small but statistically significant increase in the incidence of postdural puncture headache when comparing rates with use of 25G vs. 27G needles during CSE or DPE. However, the clinical significance of this modest increase must be weighed against the potential benefit of improved analgesia with the use of larger-gauge (25G) pencil-point spinal needles.
背景：脊髓硬膜外穿刺术（CSE）和硬膜外穿刺术（DPE）已越来越多地用于分娩镇痛，尽管没有标准的脊髓针的使用。研究表明，铅笔针可以降低硬脊膜穿刺后头痛的发生率；然而，对于最小化头痛风险同时最大化止痛效果的最佳尺寸尚无共识。方法采用单中心回顾性队列研究，对2018 - 2023年接受CSE或DPE进行轴向分娩镇痛的产妇进行研究，以确定有意（非意外）硬脊膜穿刺后头痛发生率。结果在研究期间共进行了10459例CSE和DPE手术，其中以CSE手术最为常见（91%）。对于CSE， 69%的病例使用27G针头，对于DPE，近三分之二的病例使用25G针头。54例（0.52%）患者出现硬膜穿刺后头痛（无硬膜外穿刺针意外穿刺）。25G针头比27G针头更容易发生硬脊膜后穿刺头痛（0.73% vs. 0.41%），相应的风险比为0.56 （95% CI 0.34-0.92； P=0.029）。结论：在CSE或DPE中，25G针与27G针的发生率相比，硬脊膜后穿刺头痛的发生率略有增加，但有统计学意义。然而，这种适度增加的临床意义必须与使用更大口径（25G）铅笔尖脊柱针改善镇痛的潜在益处进行权衡。
{"title":"Postdural puncture headache after neuraxial labor analgesia with 25- vs. 27-gauge Whitacre needles: a single-center retrospective cohort study (2018–2023)","authors":"M. Balot, G. Echevarria, A. Lee, B. Mahoney","doi":"10.1016/j.ijoa.2026.104849","DOIUrl":"10.1016/j.ijoa.2026.104849","url":null,"abstract":"<div><h3>Background</h3><div>Combined spinal epidural (CSE) and dural puncture epidural (DPE) procedures have become increasingly utilized for labor analgesia, though no standards exist on which spinal needle to use. It has been demonstrated that pencil-point needles reduce the rate of postdural puncture headaches; however, there is no consensus on the optimal size to minimize headache risk while maximizing analgesia.</div></div><div><h3>Methods</h3><div>A single-center retrospective cohort study was conducted of parturients receiving CSE or DPE for neuraxial labor analgesia between 2018 and 2023 to identify the postdural puncture headache rate with intended (but not unintended) dural puncture.</div></div><div><h3>Results</h3><div>A total of 10,459 CSE and DPE procedures were performed during the study period, with CSE most commonly performed (91%). For CSE, 27G needle was used in 69% of cases, and for DPE, 25G needle was used in nearly two-thirds of cases. Fifty-four patients (0.52%) experienced a postdural puncture headache (without evidence of unintended dural puncture with epidural needle). Postdural puncture headache occurred more frequently with 25G needles than with 27G needles (0.73% vs. 0.41%), corresponding to a risk ratio of 0.56 (95% CI 0.34–0.92; <em>P</em>=0.029)).</div></div><div><h3>Conclusions</h3><div>There was a small but statistically significant increase in the incidence of postdural puncture headache when comparing rates with use of 25G vs. 27G needles during CSE or DPE. However, the clinical significance of this modest increase must be weighed against the potential benefit of improved analgesia with the use of larger-gauge (25G) pencil-point spinal needles.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"66 ","pages":"Article 104849"},"PeriodicalIF":2.3,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981472","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 : 2026-01-10DOI: 10.1016/j.ijoa.2026.104848
Megan Glynn , Rosemarie Kearsley
{"title":"Letter to the Editor ‘Anaesthetic considerations for delivery in an obstetric patient with a RYR1 gene variant: a case report’","authors":"Megan Glynn , Rosemarie Kearsley","doi":"10.1016/j.ijoa.2026.104848","DOIUrl":"10.1016/j.ijoa.2026.104848","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"66 ","pages":"Article 104848"},"PeriodicalIF":2.3,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981474","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 : 2026-01-08DOI: 10.1016/j.ijoa.2026.104847
Asaf Berman , Boris Aptekman , Carolyn F Weiniger
{"title":"Planning for labor epidural analgesia in a patient with complex back surgery: a case report with the patients’ perspective","authors":"Asaf Berman , Boris Aptekman , Carolyn F Weiniger","doi":"10.1016/j.ijoa.2026.104847","DOIUrl":"10.1016/j.ijoa.2026.104847","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"66 ","pages":"Article 104847"},"PeriodicalIF":2.3,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981473","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}
Postpartum haemorrhage-induced coagulopathy is marked by early fibrinogen depletion and, in acute obstetric coagulopathy, by hyperfibrinolysis and fibrinogenolysis. It remains unclear that exogenous fibrinogen concentrate is similarly susceptible to plasmin-mediated degradation. This secondary analysis of the TRACES trial assessed fibrinogen restoration kinetics after fibrinogen concentrate administration during postpartum hemorrhage.
Methods
The TRACES trial was a multicentre, randomised, double-blind, placebo-controlled study investigating tranexamic acid dosing in haemorrhagic caesarean delivery. For this analysis, only patients receiving fibrinogen concentrate were included. All laboratory and clinical data were re-timestamped relative to the first fibrinogen concentrate administration. Hyperfibrinolysis (HF) was defined by fibrinogen < 300 mg/dL, D-dimer ≥ 50,000 ng/mL and plasmin–antiplasmin complexes ≥ 2,000 ng/mL at any time point. Fibrinogen restoration trajectories were compared between cases with HF and No HF.
Results
Among 151 patients, 34 received fibrinogen concentrate. Five met HF criteria. Despite receiving higher fibrinogen concentrate doses, HF patients showed significantly impaired fibrinogen restoration (p < 0.01), with an initial rise followed by early decline. HF status was also associated with increased blood loss during postpartum hemorrhage.
Discussion
These exploratory findings support the hypothesis that exogenous fibrinogen may undergo plasmin-mediated cleavage in acute obstetric coagulopathy, leading to restoration failure and highlight the hypothesis of fibrinogenolysis.
Conclusion
Hyperfibrinolysis markedly impairs fibrinogen concentrate-mediated fibrinogen restoration during postpartum haemorrhage. Dedicated pharmacokinetic–pharmacodynamic studies are needed to optimise fibrinogen supplementation and hemostatic strategies.
产后出血引起的凝血功能障碍以早期纤维蛋白原耗竭为特征，在急性产科凝血功能障碍中，以高纤维蛋白溶解和纤维蛋白原溶解为特征。目前尚不清楚外源性纤维蛋白原浓缩物是否同样容易受到纤溶酶介导的降解。这项对TRACES试验的二次分析评估了产后出血期间纤维蛋白原浓缩治疗后纤维蛋白原恢复动力学。方法TRACES试验是一项多中心、随机、双盲、安慰剂对照研究，研究氨甲环酸在出血性剖宫产中的剂量。本分析仅包括接受纤维蛋白原浓缩治疗的患者。所有实验室和临床数据都相对于第一次纤维蛋白原浓缩给药重新标注时间。在任何时间点，纤维蛋白原≥300 mg/dL， d -二聚体≥50,000 ng/mL，纤溶蛋白抗纤溶蛋白复合物≥2,000 ng/mL来定义高纤溶（HF）。比较HF和非HF患者的纤维蛋白原恢复轨迹。结果151例患者中，34例接受浓缩纤维蛋白原治疗。5例符合HF标准。尽管接受了较高的纤维蛋白原浓缩剂量，但HF患者的纤维蛋白原恢复明显受损（p < 0.01），最初升高，随后早期下降。HF状态也与产后出血期间出血量增加有关。这些探索性发现支持了外源性纤维蛋白原可能在急性产科凝血病中发生纤溶酶介导的裂解，导致恢复失败的假设，并强调了纤维蛋白原溶解的假设。结论高纤溶明显损害了产后出血期间纤维蛋白原浓度介导的纤维蛋白原恢复。需要专门的药代动力学-药效学研究来优化纤维蛋白原补充和止血策略。
{"title":"Hyperfibrinolysis and reduced functional fibrinogen in haemorrhagic caesarean delivery: a secondary analysis of the TRACES trial evaluating fibrinogen kinetics following fibrinogen concentrate or plasma infusion","authors":"Maxence Hureau , Julien Lanoiselée , Edouard Ollier , Emilien Abraham , Bérangère Denys , Anne-Sophie Bouthors","doi":"10.1016/j.ijoa.2026.104846","DOIUrl":"10.1016/j.ijoa.2026.104846","url":null,"abstract":"<div><h3>Introduction</h3><div>Postpartum haemorrhage-induced coagulopathy is marked by early fibrinogen depletion and, in acute obstetric coagulopathy, by hyperfibrinolysis and fibrinogenolysis. It remains unclear that exogenous fibrinogen concentrate is similarly susceptible to plasmin-mediated degradation. This secondary analysis of the TRACES trial assessed fibrinogen restoration kinetics after fibrinogen concentrate administration during postpartum hemorrhage.</div></div><div><h3>Methods</h3><div>The TRACES trial was a multicentre, randomised, double-blind, placebo-controlled study investigating tranexamic acid dosing in haemorrhagic caesarean delivery. For this analysis, only patients receiving fibrinogen concentrate were included. All laboratory and clinical data were re-timestamped relative to the first fibrinogen concentrate administration. Hyperfibrinolysis (HF) was defined by fibrinogen < 300 mg/dL, D-dimer ≥ 50,000 ng/mL and plasmin–antiplasmin complexes ≥ 2,000 ng/mL at any time point. Fibrinogen restoration trajectories were compared between cases with HF and No HF.</div></div><div><h3>Results</h3><div>Among 151 patients, 34 received fibrinogen concentrate. Five met HF criteria. Despite receiving higher fibrinogen concentrate doses, HF patients showed significantly impaired fibrinogen restoration (p < 0.01), with an initial rise followed by early decline. HF status was also associated with increased blood loss during postpartum hemorrhage.</div></div><div><h3>Discussion</h3><div>These exploratory findings support the hypothesis that exogenous fibrinogen may undergo plasmin-mediated cleavage in acute obstetric coagulopathy, leading to restoration failure and highlight the hypothesis of fibrinogenolysis.</div></div><div><h3>Conclusion</h3><div>Hyperfibrinolysis markedly impairs fibrinogen concentrate-mediated fibrinogen restoration during postpartum haemorrhage. Dedicated pharmacokinetic–pharmacodynamic studies are needed to optimise fibrinogen supplementation and hemostatic strategies.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"66 ","pages":"Article 104846"},"PeriodicalIF":2.3,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950299","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 : 2026-01-05DOI: 10.1016/j.ijoa.2026.104845
Holly B. Ende, Emily E. Sharpe, Richard Smiley
{"title":"Dexmedetomidine for cesarean delivery: clinical enthusiasm, limited evidence","authors":"Holly B. Ende, Emily E. Sharpe, Richard Smiley","doi":"10.1016/j.ijoa.2026.104845","DOIUrl":"10.1016/j.ijoa.2026.104845","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104845"},"PeriodicalIF":2.3,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145920835","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 : 2026-01-03DOI: 10.1016/j.ijoa.2026.104844
J. Kruthof , M. Samiee , J.P.W. Collins
Background
Leprosy is an infection caused by Mycobacterium leprae complex that primarily affects the skin and peripheral nerves but may also involve multiple organ systems. Although globally endemic, the disease is rare in high-income countries, and leprosy during pregnancy is infrequently reported. Immunologic adaptations of pregnancy may precipitate disease onset or exacerbate reactional states, which can complicate anesthetic management. Literature on obstetric neuraxial labor analgesia in women with leprosy is limited, with no previously documented reports describing its use during labor.
Case description
Written informed consent was obtained. A 37-year-old multiparous woman with multibacillary (lepromatous) leprosy was scheduled for induction of labor at 38 weeks for preeclampsia. She was receiving multidrug therapy with dapsone, rifampicin, and moxifloxacin. At the patient’s request, labor analgesia was provided with a dural puncture epidural at L4–L5. The lumbar puncture site was free of cutaneous lesions, and neurologic examinations were normal. Analgesia was satisfactory and delivery was uncomplicated; neurologic status was unchanged at discharge and at one-year follow-up.
Discussion
This case illustrates the successful use of neuraxial labor analgesia in a patient with multibacillary leprosy on multidrug therapy. Pre-procedure neurologic assessment, exclusion of lumbar spine lesions, and awareness of potential autonomic dysfunction are critical. This report underscores the need for careful multidisciplinary coordination and individualized anesthetic planning to provide neuraxial labor analgesia in parturients with leprosy.
{"title":"Neuraxial labor analgesia in a pregnant patient with leprosy: a case report","authors":"J. Kruthof , M. Samiee , J.P.W. Collins","doi":"10.1016/j.ijoa.2026.104844","DOIUrl":"10.1016/j.ijoa.2026.104844","url":null,"abstract":"<div><h3>Background</h3><div>Leprosy is an infection caused by <em>Mycobacterium leprae complex</em> that primarily affects the skin and peripheral nerves but may also involve multiple organ systems. Although globally endemic, the disease is rare in high-income countries, and leprosy during pregnancy is infrequently reported. Immunologic adaptations of pregnancy may precipitate disease onset or exacerbate reactional states, which can complicate anesthetic management. Literature on obstetric neuraxial labor analgesia in women with leprosy is limited, with no previously documented reports describing its use during labor.</div></div><div><h3>Case description</h3><div>Written informed consent was obtained. A 37-year-old multiparous woman with multibacillary (lepromatous) leprosy was scheduled for induction of labor at 38 weeks for preeclampsia. She was receiving multidrug therapy with dapsone, rifampicin, and moxifloxacin. At the patient’s request, labor analgesia was provided with a dural puncture epidural at L4–L5. The lumbar puncture site was free of cutaneous lesions, and neurologic examinations were normal. Analgesia was satisfactory and delivery was uncomplicated; neurologic status was unchanged at discharge and at one-year follow-up.</div></div><div><h3>Discussion</h3><div>This case illustrates the successful use of neuraxial labor analgesia in a patient with multibacillary leprosy on multidrug therapy. Pre-procedure neurologic assessment, exclusion of lumbar spine lesions, and awareness of potential autonomic dysfunction are critical. This report underscores the need for careful multidisciplinary coordination and individualized anesthetic planning to provide neuraxial labor analgesia in parturients with leprosy.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104844"},"PeriodicalIF":2.3,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145920836","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 : 2025-12-29DOI: 10.1016/j.ijoa.2025.104840
S. Ben Marzouk, B. Fouzai, N. Dhraief, F. Ben Amor, T. Hkiri, H. Hamdi, S. Trablesi, A. Kalai, H. Maghrebi
Backgrounds
Spinal anesthesia for cesarean delivery commonly causes maternal hypotension (60–80%), leading to adverse maternal and fetal outcomes. Standard crystalloid coloading is preferred over preloading, but individualized fluid strategies based on preload dependence remain untested.
Methods
In this randomized controlled trial (NCT07108881) conducted at the Tunis Maternity Center, 96 ASA II women with singleton pregnancies scheduled for elective cesarean under spinal anesthesia and preload dependent (ΔLVOT VTI ≥ 12% after passive leg raising via cardiac ultrasound) were enrolled (n=96) and randomized to one of two groups. The active group (A, n=48) received titrated crystalloid preloading (250 mL increments guided by serial LVOT VTI until < 12%) plus standard coloading (10 mL/kg) and the control group (C, n=48) received coloading alone. The primary outcome was the hypotension incidence (SBP decrease > 20% baseline). Secondary outcomes were hypotension duration, rescue fluids, ephedrine use, nausea/vomiting, Apgar scores, and umbilical pH.
Results
Groups were comparable at baseline. Hypotension incidence was lower in group A vs C (37.5% vs. 62.5%; P < 0.001; RR = 0.6, 95% CI 0.39–0.91). Hypotension duration was shorter (2.9 ± 1.4 vs. 5.2 ± 1.6 min; P = 0.012), lowest SBP higher (88 ± 7 vs. 82 ± 9 mmHg; P < 0.001), rescue crystalloids reduced (365 ± 130 vs. 482 ± 116 mL; P = 0.04), and nausea/vomiting lower (21% vs. 53%; P = 0.01). Ephedrine use and cardiac output were similar; umbilical pH was better in group A (7.34 ± 0.06 vs. 7.28 ± 0.06; P = 0.02).
Conclusion
Ultrasound-guided preload correction plus coloading reduces hypotension incidence, duration, rescue fluids, and maternal side effects in preload-dependent patients. Multicenter trials should validate integration into obstetric point of care ultrasounds protocols.
背景剖宫产脊髓麻醉通常会导致母体低血压（60-80%），导致母体和胎儿的不良结局。标准晶体加载优于预压，但基于预压依赖性的个性化流体策略仍未经过测试。方法在突尼斯产科中心进行的这项随机对照试验（NCT07108881）中，纳入96名ASA II期单胎孕妇，她们计划在脊髓麻醉下择期剖宫产，且预负荷依赖（通过心脏超声被动抬腿后ΔLVOT VTI≥12%）（n=96），并随机分为两组之一。活性组（A, n=48）在连续LVOT VTI引导下，滴加晶体预压（250 mL/kg），加标准上样（10 mL/kg），对照组（C, n=48）单独上样。主要终点是低血压发生率（基线收缩压降低20%）。次要结局是低血压持续时间、补液、麻黄素使用、恶心/呕吐、Apgar评分和脐带ph。结果两组基线比较具有可比性。A组低血压发生率低于C组（37.5%比62.5%;P < 0.001; RR = 0.6, 95% CI 0.39-0.91）。低血压持续时间较短（2.9±1.4 vs 5.2±1.6 min, P = 0.012），最低收缩压升高（88±7 vs 82±9 mmHg, P < 0.001），抢救晶体减少（365±130 vs 482±116 mL, P = 0.04），恶心/呕吐降低（21% vs 53%, P = 0.01）。麻黄碱的使用和心输出量相似；A组脐带pH值较低（7.34±0.06 vs. 7.28±0.06;P = 0.02）。结论超声引导下预负荷矫正加负荷可降低预负荷依赖患者低血压的发生率、持续时间、补液量及母体副作用。多中心试验应验证产科护理点超声方案的整合。
{"title":"Cardiac ultrasound-guided crystalloid preloading before spinal anesthesia vs. standard coloading for scheduled cesarean delivery: a randomized controlled trial","authors":"S. Ben Marzouk, B. Fouzai, N. Dhraief, F. Ben Amor, T. Hkiri, H. Hamdi, S. Trablesi, A. Kalai, H. Maghrebi","doi":"10.1016/j.ijoa.2025.104840","DOIUrl":"10.1016/j.ijoa.2025.104840","url":null,"abstract":"<div><h3>Backgrounds</h3><div>Spinal anesthesia for cesarean delivery commonly causes maternal hypotension (60–80%), leading to adverse maternal and fetal outcomes. Standard crystalloid coloading is preferred over preloading, but individualized fluid strategies based on preload dependence remain untested.</div></div><div><h3>Methods</h3><div>In this randomized controlled trial (NCT07108881) conducted at the Tunis Maternity Center, 96 ASA II women with singleton pregnancies scheduled for elective cesarean under spinal anesthesia and preload dependent (ΔLVOT VTI ≥ 12% after passive leg raising via cardiac ultrasound) were enrolled (n=96) and randomized to one of two groups. The active group (A, n=48) received titrated crystalloid preloading (250 mL increments guided by serial LVOT VTI until < 12%) plus standard coloading (10 mL/kg) and the control group (C, n=48) received coloading alone. The primary outcome was the hypotension incidence (SBP decrease > 20% baseline). Secondary outcomes were hypotension duration, rescue fluids, ephedrine use, nausea/vomiting, Apgar scores, and umbilical pH.</div></div><div><h3>Results</h3><div>Groups were comparable at baseline. Hypotension incidence was lower in group A vs C (37.5% vs. 62.5%; <em>P</em> < 0.001; RR = 0.6, 95% CI 0.39–0.91). Hypotension duration was shorter (2.9 ± 1.4 vs. 5.2 ± 1.6 min; <em>P</em> = 0.012), lowest SBP higher (88 ± 7 vs. 82 ± 9 mmHg; <em>P</em> < 0.001), rescue crystalloids reduced (365 ± 130 vs. 482 ± 116 mL; <em>P</em> = 0.04), and nausea/vomiting lower (21% vs. 53%; <em>P</em> = 0.01). Ephedrine use and cardiac output were similar; umbilical pH was better in group A (7.34 ± 0.06 vs. 7.28 ± 0.06; <em>P</em> = 0.02).</div></div><div><h3>Conclusion</h3><div>Ultrasound-guided preload correction plus coloading reduces hypotension incidence, duration, rescue fluids, and maternal side effects in preload-dependent patients. Multicenter trials should validate integration into obstetric point of care ultrasounds protocols.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"66 ","pages":"Article 104840"},"PeriodicalIF":2.3,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950298","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 : 2025-12-27DOI: 10.1016/j.ijoa.2025.104841
A Maeda, W Camann
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