International journal of obstetric anesthesia最新文献

英文中文

Cardiac ultrasound-guided crystalloid preloading before spinal anesthesia vs. standard coloading for scheduled cesarean delivery: a randomized controlled trial 在脊髓麻醉前心脏超声引导下的晶体预负荷与计划剖宫产的标准负荷：一项随机对照试验

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-05-01 Epub Date: 2025-12-29 DOI: 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。

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引用次数: 0

In response to “Dexmedetomidine for cesarean delivery: clinical enthusiasm, limited evidence” 对“右美托咪定用于剖宫产：临床热情，证据有限”的回应

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-05-01 Epub Date: 2026-01-20 DOI: 10.1016/j.ijoa.2026.104854

Daniel F. Berenson, William R. Camann

引用次数: 0

Planning for labor epidural analgesia in a patient with complex back surgery: a case report with the patients’ perspective 复杂背部手术患者的分娩硬膜外镇痛计划：从患者的角度分析一例报告

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-05-01 Epub Date: 2026-01-08 DOI: 10.1016/j.ijoa.2026.104847

Asaf Berman , Boris Aptekman , Carolyn F Weiniger

引用次数: 0

Implementation of the Ulysses contract in a patient with severe needle phobia: a case report 尤利西斯契约在严重针头恐惧症患者中的实施：1例报告

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-05-01 Epub Date: 2026-01-12 DOI: 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.

在产科麻醉中，尊重患者的自主权可能会带来复杂的挑战，特别是当母亲希望安全的母婴护理，但由于心理障碍而无法合作时。尤利西斯合同是一个框架，允许患者在以后缺乏决策能力的情况下提前同意治疗。这一案例说明了尤利西斯合同在一名产科病人中的独特执行情况，其中早期多学科支助的参与至关重要，以便根据病人的意愿提供安全和及时的医疗服务。

引用次数: 0

Anaesthesia for caesarean delivery in patients with placenta accreta spectrum: a retrospective cohort study in two referral centres in Ireland (2017–2024) 增胎性胎盘患者剖宫产麻醉：爱尔兰两家转诊中心的回顾性队列研究（2017-2024）

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-05-01 Epub Date: 2025-12-06 DOI: 10.1016/j.ijoa.2025.104830

O. Elabbasy , S. Ahmed , D. Walsh , H. Bartels , D. Brennan , M. Wilkinson , S. MacColgain , A. Doherty , R. Ffrench-O’Carroll

Background

Placenta accreta spectrum disorders represent a major anaesthetic and surgical challenge, yet there are limited published data describing anaesthetic management in Ireland. This study examined anaesthetic practices and maternal and neonatal outcomes in patients with placenta accreta spectrum undergoing caesarean delivery in two tertiary referral maternity hospitals in Ireland.

Methods

A retrospective cohort study was conducted between 2017 and 2024, including 75 women with placenta accreta spectrum. Data collected included demographics, anaesthetic techniques, intraoperative management, and maternal and neonatal outcomes. Outcomes were compared across three groups: general anaesthesia only, combined neuraxial and general anaesthesia, and neuraxial anaesthesia only.

Results

Combined neuraxial and general anaesthesia was the most common anaesthetic approach used (50.7%), with 63 patients (84%) receiving a general anaesthetic at some point during surgery. Use of general anaesthesia was employed in all non-elective cases and was associated with performance of hysterectomy (OR 6.6, 95% CI 1.34, 32.9; P = 0.02), increased blood loss (OR 1.001, 95% CI 1.00, 1.00); P = 0.043), reduced Apgar scores at 5 and 10 min (P < 0.011) and greater need for neonatal intubation (P = 0.002).

Conclusions

General anaesthesia was performed in the majority of placenta accreta spectrum cases although in many patients this was combined with neuraxial anaesthesia. General anaesthesia was associated with greater maternal blood loss and poorer neonatal outcomes, although these findings should be interpreted with caution given the performance of general anaesthesia in all non-elective cases.

背景：胎盘增生谱系障碍是一个主要的麻醉和手术挑战，但在爱尔兰，描述麻醉管理的公开数据有限。本研究调查了在爱尔兰两家三级转诊妇产医院进行剖腹产的增胎性胎盘患者的麻醉做法和产妇和新生儿结局。方法采用回顾性队列研究方法，选取2017 - 2024年伴有胎盘增生谱的女性75例。收集的数据包括人口统计学、麻醉技术、术中管理、孕产妇和新生儿结局。结果在三组之间进行比较：仅全麻，神经轴和全身联合麻醉，以及仅神经轴麻醉。结果神经轴和全身麻醉是最常见的麻醉方式（50.7%），其中63例（84%）患者在手术过程中接受了全身麻醉。所有非选择性病例均采用全身麻醉，并与子宫切除术的实施（OR 6.6, 95% CI 1.34, 32.9; P = 0.02）、出血量增加（OR 1.001, 95% CI 1.00, 1.00）相关；P = 0.043)， 5分钟和10分钟Apgar评分降低（P < 0.011），新生儿插管需求增加（P = 0.002）。结论：尽管在许多患者中，全身麻醉与神经轴麻醉相结合，但大多数增生性胎盘病例均行全身麻醉。全身麻醉与更多的产妇失血和较差的新生儿结局有关，尽管考虑到所有非选择性病例的全身麻醉表现，这些发现应谨慎解释。

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引用次数: 0

Mobilisation, breastfeeding, and quality of recovery after caesarean delivery: a nationwide prospective cohort study in Denmark with secondary analysis on the association with severe pain 动员、母乳喂养和剖腹产后恢复质量：丹麦的一项全国前瞻性队列研究，对其与严重疼痛的关系进行了二次分析

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-05-01 Epub Date: 2026-01-21 DOI: 10.1016/j.ijoa.2026.104863

Patricia Duch , Helene K. Nedergaard , Christoffer C. Jørgensen

Background

Severe postoperative pain after caesarean delivery may delay recovery by impeding mobilisation and activities of daily living and may also interfere with feeding and caregiving of the infant. This study aimed to describe maternal recovery after caesarean delivery and investigate the association between severe pain within the first 24 h after surgery and impaired mobilisation, breastfeeding, and overall quality of recovery.

Methods

This is a planned secondary analysis on a nationwide prospective cohort study across 19 centers in Denmark, with repeated patient-reported outcomes collected throughout the early postoperative hours and days postpartum, analysing recovery outcomes using multivariable regression and multiple imputation for missing data.

Results

Of 583 included patients, 64.6% reported severe pain (numeric rating scale ≥ 7) within the initial 24 h after caesarean delivery. The mean recovery score (ObsQoR-10, range 0–100) was 59.13 ± 13.0 vs. 70.55 ± 12.8 (adjusted difference −11.01, 95% CI −13.40 to −8.62; P < 0.001) in patients with vs. without severe pain, respectively. Severe pain was associated with reduced likelihood of walking independently (86% vs. 94%, adjusted OR 0.43, 95% CI 0.2 to 0.9; P = 0.030), and ability to independently breastfeed (65% vs. 75%, adjusted OR 0.61, 95% CI 0.4 to 0.9; P = 0.037) 24 h after caesarean delivery.

Conclusions

Severe pain during the first 24 h after caesarean delivery is associated with significant and clinically relevant impaired patient-reported outcome measures of recovery, mobilisation and breastfeeding. These findings support the importance of adequate post-caesarean analgesia for improving maternal recovery.

背景：剖宫产后严重的术后疼痛可能会阻碍活动和日常生活活动，从而延迟恢复，也可能影响婴儿的喂养和护理。本研究旨在描述剖宫产后产妇的恢复情况，并调查术后24小时内剧烈疼痛与活动能力受损、母乳喂养和整体恢复质量之间的关系。方法：这是一项针对丹麦19个中心的全国性前瞻性队列研究的计划二级分析，在术后早期和产后几天内收集重复的患者报告结果，使用多变量回归和对缺失数据的多重代入分析恢复结果。结果583例纳入的患者中，64.6%的患者在剖宫产后最初24小时内报告了剧烈疼痛（数值评定量表≥7）。有无剧烈疼痛患者的平均恢复评分（ObsQoR-10，范围0-100）分别为59.13±13.0和70.55±12.8（校正差为- 11.01,95% CI为- 13.40至- 8.62;P < 0.001）。严重疼痛与剖宫产后24小时独立行走可能性降低（86%对94%，校正OR 0.43, 95% CI 0.2 ~ 0.9; P = 0.030）和独立母乳喂养能力降低（65%对75%，校正OR 0.61, 95% CI 0.4 ~ 0.9; P = 0.037）相关。结论：剖宫产后24小时内的剧烈疼痛与患者报告的恢复、活动和母乳喂养的预后指标明显受损相关。这些发现支持充分的剖腹产后镇痛对改善产妇康复的重要性。

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引用次数: 0

Obstetric anesthesia in Latin America: a workforce and clinical practice survey (2025) 拉丁美洲产科麻醉：劳动力和临床实践调查（2025）

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-05-01 Epub Date: 2025-11-16 DOI: 10.1016/j.ijoa.2025.104818

Hector J. Lacassie , René de la Fuente , Mauricio Vasco , Mónica Siaulys

Background

This study offers the first comprehensive assessment of the obstetric anesthesia workforce in Latin America. It aims to describe workforce composition, clinical practices, and safety protocols, and compares findings with United States data.

Methods

A web-based, anonymous survey was administered in August 2025 to national leaders in obstetric anesthesia from 24 Latin American countries. The survey tool was adapted from the United States Obstetric Anesthesia Workforce Survey. Responses were descriptively analyzed and averaged after weighting for national birth rates. Comparisons with United States data were descriptive.

Results

Of 62 anesthesiologists contacted from 19 countries, 50 responded. Most respondents (90%) worked in high-risk referral hospitals, and 54% in academic centers with residency programs. During daytime, 50% reported non-obstetric concurrent duties, increasing to 60% after hours. Neuraxial labor analgesia was provided in 69% of cases (epidural 37%, combined spinal epidural 23%, dural puncture epidural 3.4%, single spinal 3.8%); 26% of laboring patients received no analgesia. Spinal anesthesia was most common for planned cesarean delivery (86%), with intrathecal morphine used in 83% of centers. Enhanced Recovery protocols were used in 27%. General anesthesia was reported in 18% of urgent cesarean deliveries. Safety measures—massive transfusion protocols, advanced life support training, and ultrasound—were available in 79%, 69%, and 87% of centers.

Conclusions

The survey reveals strengths including high rates of neuraxial analgesia and safety protocols, but substantial variation in staffing, analgesia, and techniques. Opportunities exist to expand coverage, standardize practices, and improve maternal safety in Latin America.

本研究首次对拉丁美洲的产科麻醉人员进行了全面评估。它旨在描述劳动力构成、临床实践和安全协议，并将研究结果与美国数据进行比较。方法于2025年8月对来自24个拉丁美洲国家的产科麻醉负责人进行了一项基于网络的匿名调查。调查工具改编自美国产科麻醉劳动力调查。对回答进行描述性分析，并对全国出生率进行加权后取平均值。与美国数据的比较是描述性的。结果在联系的来自19个国家的62名麻醉师中，有50名做出了回应。大多数受访者（90%）在高风险转诊医院工作，54%在有住院医师项目的学术中心工作。在白天，50%的人报告了非产科的同时工作，下班后增加到60%。69%的病例接受了轴向分娩镇痛（硬膜外37%，脊髓硬膜外联合23%，硬膜外穿刺3.4%，单脊髓3.8%）；26%的分娩患者未使用镇痛药。脊髓麻醉在计划剖宫产中最为常见（86%），83%的中心使用鞘内吗啡。27%的患者采用了增强恢复方案。据报道，18%的紧急剖宫产患者采用全身麻醉。安全措施——大量输血方案、先进的生命支持训练和超声波——在79%、69%和87%的中心都是可行的。结论：调查显示其优势包括较高的轴向镇痛率和安全方案，但在人员配置、镇痛和技术方面存在很大差异。拉丁美洲存在扩大覆盖面、规范做法和改善孕产妇安全的机会。

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引用次数: 0

Letter to the Editor ‘Anaesthetic considerations for delivery in an obstetric patient with a RYR1 gene variant: a case report’ 致编辑的信“RYR1基因变异产科患者分娩时的麻醉考虑：一个病例报告”

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-05-01 Epub Date: 2026-01-10 DOI: 10.1016/j.ijoa.2026.104848

Megan Glynn , Rosemarie Kearsley

引用次数: 0

In response to “Cardiac ultrasound-guided crystalloid preloading before spinal anesthesia vs. standard coloading for scheduled cesarean delivery: a randomized controlled trial” 针对“心脏超声引导下的脊髓麻醉前晶体预压与计划剖宫产的标准预压：一项随机对照试验”

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-05-01 Epub Date: 2026-01-20 DOI: 10.1016/j.ijoa.2026.104853

Mina Adolf Helmy, Lydia Magdy Milad

引用次数: 0

Intrapartum care for transgender and gender-diverse individuals: an Obstetric Anaesthetists Association (OAA) members’ perspective survey (2025) 跨性别和性别多样化个体的产时护理：产科麻醉师协会（OAA）成员的观点调查（2025）

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2026-05-01 Epub Date: 2026-01-12 DOI: 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.

背景：越来越多的跨性别者和性别多样化的个体获得产科服务，但与他们的分娩护理有关的证据仍然有限。本研究调查了在英国（UK）执业的产科麻醉师，以探索经验、培训、部门政策和对语言和护理的看法。方法于2025年6月向产科麻醉师协会（OAA）会员发放一份包含13个问题的匿名在线调查。定量的回答是描述性的总结，自由文本的回答是通过反复出现的主题进行审查。结果回复率较低（13.7%），共分析262份回复率。大多数受访者是顾问，近一半的人有十年以上的工作经验。正规培训并不常见，几乎一半的人报告从未为变性患者提供过分娩时护理。很少有人报告部门的政策，而且舒适度各不相同。大多数人认为包容性语言改善了护理。这项对英国OAA成员的调查显示，跨性别和性别多样化的分娩护理在经验和系统支持方面存在差距，缺乏跨性别产科麻醉护理培训，以及尊重、以患者为中心的沟通的重要性。

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