International journal of obstetric anesthesia最新文献_第7页

“This is how we do it” Anaesthesia for uterine transplant and associated surgeries: the Australian-Swedish collaborative protocol 子宫移植及相关手术的麻醉：澳大利亚-瑞典合作协议

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-23 DOI: 10.1016/j.ijoa.2025.104800

G. Caponas , R. Deans , S. Letafat , I. Stewart , M. Brännström , J. Abbott , C. Downs

Uterine transplantation represents a groundbreaking fertility treatment for individuals with uterine factor infertility. Since the first successful live birth from uterine transplantation in 2014, surgical technique and outcomes have been widely reported yet published anaesthetic guidance remains limited. Australia’s first uterine transplantation was performed in early 2023 at the Royal Hospital for Women, Sydney, Australia.

Anaesthesia for uterine transplantation is complex, requiring multidisciplinary planning. Donor hysterectomy is an extended procedure (8 to 12 h) involving radical dissection, anticoagulation, thromboembolic prophylaxis, and postoperative pain control, with epidural analgesia. Recipient surgery, while shorter (4 to 7 h), demands coordination between surgical teams to minimise graft ischaemia time and optimise immunosuppressant administration. Aseptic technique and haemodynamic monitoring are critical components of perioperative care.

Following uterine transplantation, recipients may require anaesthesia for cervical biopsies for rejection surveillance or for embryo transfer. These procedures may be prior to, or during pregnancy. Obstetric anaesthetic considerations include the impact of immunosuppression, heightened risks of preeclampsia and acute kidney injury and preterm delivery, and requirements for perioperative planning of caesarean section. Elective and emergency caesarean deliveries can be successfully managed with combined spinal-epidural anaesthesia, with special attention to haemorrhage risk and postoperative analgesia. The final stage of the uterine transplantation pathway is graft hysterectomy, performed electively following completed fertility treatment or for medical indications.

This review outlines the anaesthetic considerations for uterine transplantation and all related surgeries, providing insights into perioperative planning, multidisciplinary collaboration, and evolving protocols drawing on the experience at the Royal Hospital for Women.

The uterine transplants referred to in this paper were part of a clinical trial, registration number ACTRN12622000917730, Ethics approval 2019/ETH13038.

子宫移植是一种开创性的生育治疗与子宫因素不孕的个体。自2014年首例成功的子宫移植活产以来，手术技术和结果被广泛报道，但发表的麻醉指导仍然有限。澳大利亚首例子宫移植手术于2023年初在澳大利亚悉尼皇家妇女医院进行。子宫移植的麻醉是复杂的，需要多学科的规划。供体子宫切除术是一个延长的过程（8至12小时），涉及根治性清扫、抗凝、血栓栓塞预防和术后疼痛控制，并伴有硬膜外镇痛。受体手术虽然较短（4至7小时），但需要手术团队之间的协调，以最大限度地减少移植物缺血时间并优化免疫抑制剂的施用。无菌技术和血流动力学监测是围手术期护理的重要组成部分。子宫移植后，受者可能需要麻醉进行宫颈活检以监测排斥反应或胚胎移植。这些程序可以在怀孕前或怀孕期间进行。产科麻醉的考虑因素包括免疫抑制的影响、子痫前期、急性肾损伤和早产的风险增加以及剖宫产围手术期计划的要求。选择性和紧急剖宫产可通过脊髓-硬膜外联合麻醉成功管理，特别注意出血风险和术后镇痛。子宫移植途径的最后阶段是移植物子宫切除术，在完成生育治疗或医学指征后选择性地进行。这篇综述概述了子宫移植和所有相关手术的麻醉注意事项，为围手术期计划、多学科合作和借鉴皇家妇女医院经验的发展方案提供了见解。本文中提到的子宫移植是临床试验的一部分，注册号为ACTRN12622000917730，伦理批准2019/ETH13038。

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引用次数: 0

Anesthetic management of congenital methemoglobinemia in emergency caesarean delivery: a case report 急诊剖宫产中先天性高铁血红蛋白血症的麻醉处理：1例报告

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-22 DOI: 10.1016/j.ijoa.2025.104807

M. Büyükcavlak

引用次数: 0

Outcomes with intrathecal 2-chloroprocaine 3% 60 mg and fentanyl 15 μg for cervical cerclage: a retrospective quality assurance study (2021 – 2023) 鞘内2-氯普鲁卡因3% 60 mg和芬太尼15 μg用于宫颈环扎术的结果：一项回顾性质量保证研究（2021 - 2023）

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-22 DOI: 10.1016/j.ijoa.2025.104808

Ebubechukwu Obiora , Richard M. Smiley , Prahlad G. Menon , Allison J. Lee

Background

In a prior study at our institution comparing intrathecal chloroprocaine to bupivacaine for spinal anesthesia for cervical cerclage, the use of intrathecal 2- chloroprocaine 3% 50 mg with fentanyl 15 μg was associated with intraoperative discomfort in 9% of patients, prompting a practice change to increase the dose to 60 mg. We report outcomes from two years of experience with the higher dose.

Methods

We conducted a retrospective chart review of patients who underwent transvaginal cervical cerclage with spinal anesthesia with 2-chloroprocaine 3% 60 mg and fentanyl 15 μg (July 2021 − July 2023). Outcomes included surgery duration, anesthetic supplementation, time from spinal injection to meet discharge criteria, and postoperative concerns documented during postoperative day 1 phone calls (n=122, available from July 2022).

Results

A total of 208 patients were included. The median surgery duration was 17 [11–25] min. A lower supplementation rate was observed with 60 mg (2% vs 9% (2/22)), but the study lacked statistical power to confirm a significant difference (P = 0.104); none required general anesthesia. The median time from spinal injection to discharge was 186 [163–218] min, compared with 158 [137–188] min in the prior 50 mg cohort (median difference −15.0 min (−20.5 to −9.5, P < 0.001). No patients reported transient neurologic symptoms, difficulty ambulating, or voiding. One reported back pain, and three reported abdominal discomfort.

Conclusion

Intrathecal 2-chloroprocaine 3% 60 mg with fentanyl showed fewer anesthetic failures (but this was not statistically significant) and a modestly longer discharge time than 50 mg.

在我们机构之前的一项研究中，比较了鞘内氯普鲁卡因和布比卡因用于颈椎环扎术的脊髓麻醉，鞘内使用2-氯普鲁卡因3% 50 mg和芬太尼15 μg与9%的患者术中不适相关，促使实践改变剂量增加到60 mg。我们报告两年来高剂量治疗的结果。方法回顾性分析2021年7月~ 2023年7月在2-氯普鲁卡因3% 60 mg和芬太尼15 μg脊髓麻醉下行阴道宫颈环切术的患者。结果包括手术持续时间、麻醉补充、从脊髓注射到满足出院标准的时间，以及术后第1天电话记录的术后问题（n=122，从2022年7月开始）。结果共纳入患者208例。中位手术时间为17[11-25]分钟。60 mg组的补给率较低（2% vs 9%(2/22)），但该研究缺乏统计学能力来证实显著差异（P = 0.104）；没有人需要全身麻醉。从脊髓注射到出院的中位时间为186[163-218]分钟，而先前50 mg队列的中位时间为158[137-188]分钟(中位差异为- 15.0分钟（- 20.5至- 9.5,P < 0.001）。无患者报告短暂性神经症状、行走困难或排尿。1人报告背部疼痛，3人报告腹部不适。结论鞘内2-氯普鲁卡因3% 60 mg联合芬太尼麻醉失败较少（但无统计学意义），出院时间略长于50 mg。

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引用次数: 0

In response to “Obstetric anesthesia in Japan: an existential crisis in need of an intervention” 回应“日本的产科麻醉：需要干预的生存危机”

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-21 DOI: 10.1016/j.ijoa.2025.104805

K. Ogawa, H. Azuma, F. Shimizu, K. Yamano, S. Wada

引用次数: 0

Ultrasound assessment of cricothyroid membrane anatomy before and after labor: a prospective observational study 产前和产后环甲膜解剖的超声评估：一项前瞻性观察研究

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-19 DOI: 10.1016/j.ijoa.2025.104802

J.F. Casellato , F.B. Zasso , E. Wild , X.Y. Ye , K. Downey , E. You-Ten , N. Siddiqui

Background

Pregnant patients are at increased risk of airway management difficulties. Ultrasound is a valuable tool for predicting difficult intubation and improving cricothyrotomy success in simulation models. We investigated whether labor and delivery alter the anatomy of the cricothyroid membrane. Methods: In this prospective observational study, we enrolled parturients in early active labor. Ultrasound was used to measure cricothyroid membrane depth (primary outcome), and cricothyroid membrane height and neck circumference (secondary outcomes). Measurements at enrollment and post-delivery were compared using the Wilcoxon signed-rank test. Results: Fifty patients were included in the final analysis. At enrollment, the median [interquartile range] cricothyroid membrane depth was 0.80 [0.63–0.96] cm, height 1.03 [0.80–1.16] cm, and neck circumference 37.0 [34.5–38.5] cm. Cricothyroid membrane depth and neck circumference were significantly greater after labor (median difference 0.03 cm, 95% CI 0.004 to 0.09, P = 0.034; and 1.0 cm, 95% CI 0.50 to 1.50, P < 0.001, respectively), while cricothyroid membrane height remained unchanged (median difference 0.01 cm, 95% CI –0.06 to 0.10, P = 0.85). Body mass index ≥35 and total oxytocin dose were associated with increased neck circumference; no other labor-related factors were significantly associated with cricothyroid membrane measurements. Conclusion: cricothyroid membrane depth increased slightly during labor, but the change fell within expected ultrasound variability and is unlikely to be clinically significant. Neck circumference increased and was associated with body mass index ≥35 and oxytocin dose. These findings require validation in larger studies.

背景：孕妇气道管理困难的风险增加。在模拟模型中，超声是预测插管困难和提高环甲环切开术成功率的有价值的工具。我们研究了分娩是否会改变环甲膜的解剖结构。方法：在这项前瞻性观察研究中，我们招募了早期活产的产妇。超声测量环甲膜深度（主要结局）、环甲膜高度和颈围（次要结局）。采用Wilcoxon符号秩检验比较入组时和分娩后的测量值。结果：50例患者纳入最终分析。入组时，环甲膜深度中位数[四分位数间距]为0.80 [0.63-0.96]cm，高度为1.03 [0.80 - 1.16]cm，颈围为37.0 [34.5-38.5]cm，产程后环甲膜深度和颈围明显大于产程后(中位数差异0.03 cm, 95% CI 0.004 ~ 0.09, P = 0.034；和1.0 cm， 95% CI分别为0.50 ~ 1.50,P < 0.001)，而环甲膜高度保持不变（中位数差异为0.01 cm， 95% CI为-0.06 ~ 0.10,P = 0.85）。体重指数≥35和催产素总剂量与颈围增加相关；没有其他与劳动相关的因素与环甲膜测量显著相关。结论：产程中环甲膜深度略有增加，但这种变化在超声变异性范围内，不太可能具有临床意义。颈围增加，并与体重指数≥35和催产素剂量相关。这些发现需要在更大规模的研究中得到验证。

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引用次数: 0

Obstetric critical care admissions to a tertiary referral hospital from a level 1 obstetric unit in Ireland – a single center retrospective observational study (2019–2023) 爱尔兰一级产科住院至三级转诊医院的产科重症住院情况——一项单中心回顾性观察研究（2019-2023年）。

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-17 DOI: 10.1016/j.ijoa.2025.104803

Ciara Luke, Amy Walsh, Sabina Czernecka, Erika Shanley, Seosamh O’ Riain, Nicholas Barrett, Catherine M. Nix

Background

Current gaps in the provision of obstetric critical care in Europe, potentially compromising patient safety and the childbirth experience, have been recognised. However, data on indications for critical care admission from stand-alone obstetric units remain scarce. We evaluated the indications for transfer from a community level 1 obstetric unit to the critical care department of a tertiary referral hospital, and describe management of these obstetric admissions.

Methods

All obstetric admissions to the high dependency/intensive care unit in a tertiary referral hospital providing critical care services to a level 1 obstetric unit in Ireland were evaluated. Data collected included the indication for transfer, obstetric data, type and number of organ support, length of stay, and maternal outcomes.

Results

Between 2019 and 2023, 81 women were admitted to the critical care department of which 24 were still pregnant (29.6%), with haemorrhage as the most common indication. Obstetric admission represented 0.9% of high dependency and 1.9% of all intensive care unit admissions. Mechanical ventilation occurred in 40% of intensive care admissions, and

\geq

2 types of organ support in 36% of patients. There were no maternal deaths.

Conclusion

Less than 0.5% of obstetric patients were transferred from a stand-alone obstetric unit for maternal critical care. Though obstetric patients represented only 1.9% of all intensive care unit admissions in the tertiary referral centre, a significant proportion were admitted before delivery. This emphasizes the importance for critical care staff to be adequately trained and resourced in the management of pregnant and postpartum patients.

背景：目前在欧洲提供产科重症护理的差距，可能危及患者安全和分娩经验，已被承认。然而，关于独立产科病房重症监护入院指征的数据仍然很少。我们评估了从社区一级产科转到三级转诊医院重症监护室的指征，并描述了这些产科入院的管理。方法：对爱尔兰一家三级转诊医院的高依赖性/重症监护病房的所有产科入院情况进行评估，该医院为一级产科病房提供重症监护服务。收集的数据包括转院指征、产科数据、器官支持类型和数量、住院时间和产妇结局。结果：2019年至2023年，81名妇女入住重症监护室，其中24名仍在怀孕（29.6%），出血是最常见的指征。产科住院占高度依赖患者的0.9%，占所有重症监护病房住院患者的1.9%。40%的重症监护住院患者采用机械通气，36%的患者采用≥2种器官支持。没有产妇死亡。结论：不到0.5%的产科患者从独立产科病房转到产妇重症监护。虽然产科病人只占三级转诊中心重症监护病房入院人数的1.9%，但很大一部分是在分娩前入院的。这强调了重症监护人员在管理孕妇和产后患者方面得到充分培训和资源的重要性。

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引用次数: 0

Factors associated with breakthrough pain with labor epidural analgesia: a single-center prospective study 分娩时硬膜外镇痛引起突破性疼痛的相关因素：一项单中心前瞻性研究

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-14 DOI: 10.1016/j.ijoa.2025.104801

K. Sassi , L. Martin , M. Noly , P. Guerby , V. Minville

Background

Breakthrough pain requiring anesthesiologist intervention occurs in 14–55% of parturients despite labor epidural analgesia, substantially affecting the childbirth experience. Identifying predictive factors may enable more effective, individualized pain management.

Methods

In this prospective observational study conducted at a tertiary maternity center, 237 parturients received standardized labor epidural analgesia. Breakthrough pain was defined as a patient-reported pain score ≥ 4 on a 0–10 numeric rating scale despite a functioning epidural, unrelieved by patient- controlled epidural analgesia, and requiring anesthesiologist intervention. Univariate and multivariable logistic regression analyses were performed to identify independent predictors.

Results

Breakthrough pain occurred in 78 parturients (32.9%). Maternal satisfaction was significantly lower among affected parturients (75.6% vs 95.6% high satisfaction; P < 0.001). Three independent predictors were identified: Rapid labor (odds ratio [OR] 29.41; 95% confidence interval [CI] 9.64–89.71), endometriosis (OR 13.89; 95% CI 1.89–102.04), and cervical dilatation at epidural placement (OR 0.74 per cm; 95% CI 0.63–0.88).

Conclusions

Rapid labor, endometriosis, and early epidural placement independently predict breakthrough pain during labor epidural analgesia. Closer monitoring and anticipatory management in these at-risk parturients may enhance analgesic effectiveness and maternal satisfaction.

背景：14-55%的产妇尽管在分娩时采用硬膜外镇痛，但仍发生需要麻醉师干预的突破性疼痛，这严重影响了分娩体验。识别预测因素可能会使疼痛管理更有效、个性化。方法本前瞻性观察研究在某三级妇产中心进行，237例产妇接受了标准化的分娩硬膜外镇痛。突破疼痛定义为：尽管硬膜外功能正常，但患者报告的疼痛评分≥4分（0-10），患者控制的硬膜外镇痛无法缓解，需要麻醉师干预。进行单变量和多变量逻辑回归分析以确定独立预测因子。结果突破性疼痛78例（32.9%）。受影响的产妇满意度明显较低（75.6%对95.6%的高满意度；P < 0.001）。确定了三个独立的预测因素：快速分娩（优势比[OR] 29.41； 95%可信区间[CI] 9.64-89.71）、子宫内膜异位症（优势比[OR] 13.89； 95%可信区间[CI] 1.89-102.04）和硬膜外放置时宫颈扩张（优势比[OR] 0.74 / cm； 95%可信区间[CI] 0.63-0.88）。结论快速分娩、子宫内膜异位症和早期硬膜外置入术独立预测分娩时硬膜外镇痛的突破痛。对这些高危产妇进行更密切的监测和预期管理可提高镇痛效果和产妇满意度。

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引用次数: 0

Post-caesarean analgesia – a multicentre retrospective analysis comparing practices in Queensland, Australia (2019–2022) 剖宫产后镇痛——澳大利亚昆士兰州（2019-2022）多中心回顾性分析

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-14 DOI: 10.1016/j.ijoa.2025.104794

V.A. Eley , S Okano , S. Lawrence , S. Bertrand , A. Kothari , D Whitcombe , M.G. Godsall

Background

Optimising post-caesarean analgesia is important to facilitate quality maternal recovery. We described post-caesarean analgesia and patient satisfaction to determine alignment with expert recommendations and described practice changes over time.

Methods

This retrospective multisite study included patients undergoing caesarean delivery in public hospitals in Queensland. We evaluated the use of long-acting neuraxial opioid; additional regional analgesia techniques; simple analgesics and “as-required” oral opioids for rescue and patient satisfaction. Differences between the first 6-month and last 7-month periods were compared.

Results

Of 27,867 patients reported between January 2019 and July 2022, 25,531 (91.6%) received neuraxial anaesthesia. Of those, 12 341 (48.3%) received neuraxial morphine/hydromorphone. Regional techniques were more common after general anaesthesia (GA, primary or secondary) compared with neuraxial anaesthesia (adjusted P < 0.001). Paracetamol was used in 27,754 (99.6%) and nonsteroidal anti-inflammatory drugs (NSAIDs) in 26,231 (94.1%). The most common oral analgesia combination was paracetamol, NSAIDs, immediate-release oxycodone and slow-release oxycodone (8035, 30.6%). Of all patients, 25,294 (90.8%) were satisfied/very satisfied and more patients having neuraxial anaesthesia were satisfied/very satisfied (adjusted P < 0.001).

Use of long-acting neuraxial opioid increased significantly from 1544 of 3242 (48%) to 2847 of 4307 (66%) during the interval studied (P < 0.001). Use of slow-release oxycodone decreased from 2403 (67%) to 2255 (48%). Buprenorphine use increased from 181 (5%) to 981 (21%) and tramadol from 1299 (36%) to 2258 (48%), all P < 0.001.

Conclusions

Use of long-acting neuraxial opioid and oral atypical opioids increased, while commonly prescribed slow-release opioid declined with time. Compliance with opioid-sparing principles can be significantly improved.

背景：优化剖宫产后镇痛对促进产妇高质量康复具有重要意义。我们描述了剖宫产后镇痛和患者满意度，以确定与专家建议的一致性，并描述了实践随时间的变化。方法回顾性多地点研究纳入昆士兰州公立医院剖宫产患者。我们评估了长效轴向阿片类药物的使用；其他局部镇痛技术；简单镇痛药和“按需”口服阿片类药物用于抢救和患者满意度。比较了前6个月和后7个月期间的差异。结果在2019年1月至2022年7月报告的27,867例患者中，25,531例（91.6%）接受了轴向麻醉。其中12341例（48.3%）接受了轴向吗啡/氢吗啡酮治疗。与轴神经麻醉相比，全麻（GA，原发性或继发性）后区域技术更常见（校正P <； 0.001）。27754例（99.6%）使用扑热息痛，26231例（94.1%）使用非甾体类抗炎药（NSAIDs）。最常见的口服镇痛组合是扑热息痛、非甾体抗炎药、速释羟考酮和缓释羟考酮（8035例，30.6%）。在所有患者中，满意/非常满意的患者为25294例（90.8%），满意/非常满意的患者较多（调整P <； 0.001）。在研究期间，长效轴向阿片类药物的使用从3242 / 1544（48%）显著增加到4307 / 2847 (66%)（P < 0.001）。缓释羟考酮的使用从2403例（67%）下降到2255例（48%）。丁丙诺啡的使用从181例（5%）增加到981例（21%），曲马多的使用从1299例（36%）增加到2258例（48%），P均为0.001。结论长效轴向阿片类药物和口服非典型阿片类药物用量随时间增加而增加，常用缓释阿片类药物用量随时间减少而减少。阿片类药物节约原则的依从性可以显著提高。

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引用次数: 0

Inpatient postpartum recovery following episiotomy: secondary outcomes of a prospective observational study 会阴切开术后住院产后恢复：一项前瞻性观察性研究的次要结果

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-12 DOI: 10.1016/j.ijoa.2025.104798

D.H. Ben Hayoun , P. Sultan , R. Eshel , N. Guo , B. Carvalho , C.F. Weiniger

Background

Data regarding the effect of episiotomy on postpartum recovery is limited. This study aimed to examine the impact of episiotomy on quality of inpatient postpartum recovery following spontaneous and operative vaginal delivery.

Methods

We performed a secondary analysis on a prospective cohort study on women with term deliveries of healthy neonates who completed a survey within 24–48 h postpartum. The survey included maternal, obstetric, and demographic data, and the validated postpartum recovery tool (ObsQoR-10-Heb). The primary outcome was postpartum recovery scores from the ObsQoR tool following spontaneous vaginal delivery (SVD) with and without episiotomy (mean ± standard deviation). Secondary outcomes included postpartum recovery scores after operative vaginal delivery (OVD) with and without episiotomy, and comparisons to elective and emergency cesarean delivery (CD). Additionally, we sought to identify specific ObsQoR items contributing to poor recovery among patients following episiotomy.

Results

Data on 325 women were available for analysis. The ranked order of postpartum recovery scores was SVD without episiotomy (80.58 ± 12.15), OVD without episiotomy (72.22 ± 19.41), SVD with episiotomy (69.38 ± 13.59), elective CD (68.61 ± 16.28), OVD with episiotomy (68.00 ± 15.57), and emergency CD (55.63 ± 16.89), reflecting the poorest recovery. Mean difference in score among women undergoing SVD with and without episiotomy was −11.2 (95% CI −18.4 to −4.0; P < 0.001). Mean difference in scores following OVD with and without episiotomy was −4.2 (95% CI −19.7 to 11.2; P = 0.970). Among recovery items, pain and discomfort ranked lowest for all delivery modes, contributing most to the reduced recovery score.

Conclusions

Episiotomy negatively impacts inpatient postpartum recovery after SVD. Pain and maternal discomfort are key factors adversely affecting recovery across all delivery modes.

背景：关于会阴切开术对产后恢复影响的资料有限。本研究旨在探讨会阴切开术对自然和手术阴道分娩后住院产后恢复质量的影响。方法：我们对一项前瞻性队列研究进行了二次分析，研究对象是在产后24-48小时内完成调查的足月健康新生儿妇女。调查包括孕产妇、产科和人口统计数据，以及经过验证的产后恢复工具（ObsQoR-10-Heb）。主要观察指标为有和没有外阴切开术的自发性阴道分娩（SVD）后的ObsQoR工具的产后恢复评分（平均值±标准差）。次要结局包括伴有和不伴有外阴切开术的阴道手术分娩（OVD）后的产后恢复评分，以及与选择性和紧急剖宫产（CD）的比较。此外，我们试图确定导致会阴切开术后患者恢复不良的特定ObsQoR项目。结果325名妇女的数据可供分析。产后恢复评分排序为：未切开外阴的SVD（80.58±12.15）、未切开外阴的OVD（72.22±19.41）、切开外阴的SVD（69.38±13.59）、择期CD（68.61±16.28）、切开外阴的OVD（68.00±15.57）、急诊CD（55.63±16.89）。接受外阴切开术和不接受外阴切开术的SVD妇女的平均评分差异为- 11.2 （95% CI为- 18.4至- 4.0;P < 0.001）。有和没有外阴切开术的OVD评分的平均差异为- 4.2 （95% CI为- 19.7 ~ 11.2;P = 0.970）。在恢复项目中，疼痛和不适在所有分娩方式中排名最低，对恢复得分的降低贡献最大。结论裂口切开术对SVD术后住院患者的产后恢复有负面影响。疼痛和产妇不适是影响所有分娩方式恢复的关键因素。

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引用次数: 0

Anesthetic management of intrapartum cesarean deliveries with an in-situ epidural catheter during second-stage versus first-stage of labor: a single-center retrospective study (2022–2024) 剖宫产第二产程与第一产程硬膜外原位导管的麻醉管理：单中心回顾性研究（2022-2024）

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia

Pub Date : 2025-10-11 DOI: 10.1016/j.ijoa.2025.104799

C. Delgado, W. Van Cleve, T. Vu, C. Hajjar, P. Keasler

Background

Inadequate anesthesia during cesarean delivery can occur in up to 15% of cases. Second-stage cesarean delivery is associated with increased surgical complexity. We evaluated whether several anesthesia-relevant outcomes differed between first- and second-stage cesareans in patients with an in-situ epidural at our referral institution.

Methods

Using a quasi-experimental design, we retrospectively analyzed all intrapartum cesareans with in-situ epidural catheters performed from 2022 to 2024. Maternal, obstetric, neuraxial and intraoperative variables were abstracted. Outcomes were intravenous analgesic or sedative administration, epidural replacement, conversion to general anesthesia, operating-room preparation time, and cesarean duration. After propensity score matching for pre-procedural variables, differences in these outcomes comparing first- and second-stage cesarean cases were examined using effect sizes.

Results

Among 968 intrapartum cesarean cases, 26% occurred during the second stage of labor. Differences in BMI, rates of labor augmentation, and requirement for epidural top-ups were observed and were mitigated by propensity score matching. Second-stage cesarean cases occurred predominantly due to arrest of stage, with higher rates of uterine atony, postpartum hemorrhage, hysterotomy extension, and longer procedural times. Longer analgesia duration was associated with increased operating room preparation time, cesarean duration, and neuraxial replacement before procedure. Rates of intraoperative intravenous adjunct use and conversion to general anesthesia were comparable across stages and analgesia duration.

Conclusions

After propensity score matching, stage of labor at the time of procedure was not associated with increased intravenous adjunct use or general anesthesia conversion for intrapartum cesareans. Neuraxial anesthesia remains a reliable choice for second-stage cesarean delivery when managed proactively, though prolonged analgesia warrants vigilance for catheter replacement before surgery.

背景：高达15%的剖宫产病例麻醉不足。第二阶段剖宫产与手术复杂性增加有关。我们评估了在我们的转诊机构进行原位硬膜外剖宫产的患者的第一和第二阶段剖宫产的几个麻醉相关结果是否不同。方法采用准实验设计，回顾性分析2022年至2024年所有硬膜外置管剖宫产术。提取了产妇、产科、神经轴和术中变量。结果为静脉镇痛或镇静给药、硬膜外替代、转全麻、手术室准备时间和剖宫产时间。在对术前变量进行倾向评分匹配后，使用效应量检查比较第一阶段和第二阶段剖宫产病例的这些结果的差异。结果968例产时剖宫产中，26%发生在第二产程。观察到BMI、助产率和硬膜外补液需求的差异，并通过倾向评分匹配减轻了差异。第二阶段剖宫产病例主要是由于阶段停止，子宫张力增高，产后出血，剖宫产延长，手术时间延长。较长的镇痛时间与手术前手术室准备时间、剖宫产时间和神经轴置换术的增加有关。术中静脉辅助麻醉的使用率和全麻转换率在不同阶段和镇痛持续时间具有可比性。结论经倾向评分匹配后，手术时的产程与宫内剖宫产中静脉辅助麻醉或全麻转换的增加无关。当主动管理时，轴向麻醉仍然是第二阶段剖宫产的可靠选择，尽管在手术前延长镇痛需要警惕导管更换。

{"title":"Anesthetic management of intrapartum cesarean deliveries with an in-situ epidural catheter during second-stage versus first-stage of labor: a single-center retrospective study (2022–2024)","authors":"C. Delgado, W. Van Cleve, T. Vu, C. Hajjar, P. Keasler","doi":"10.1016/j.ijoa.2025.104799","DOIUrl":"10.1016/j.ijoa.2025.104799","url":null,"abstract":"<div><h3>Background</h3><div>Inadequate anesthesia during cesarean delivery can occur in up to 15% of cases. Second-stage cesarean delivery is associated with increased surgical complexity. We evaluated whether several anesthesia-relevant outcomes differed between first- and second-stage cesareans in patients with an in-situ epidural at our referral institution.</div></div><div><h3>Methods</h3><div>Using a quasi-experimental design, we retrospectively analyzed all intrapartum cesareans with in-situ epidural catheters performed from 2022 to 2024. Maternal, obstetric, neuraxial and intraoperative variables were abstracted. Outcomes were intravenous analgesic or sedative administration, epidural replacement, conversion to general anesthesia, operating-room preparation time, and cesarean duration. After propensity score matching for pre-procedural variables, differences in these outcomes comparing first- and second-stage cesarean cases were examined using effect sizes.</div></div><div><h3>Results</h3><div>Among 968 intrapartum cesarean cases, 26% occurred during the second stage of labor. Differences in BMI, rates of labor augmentation, and requirement for epidural top-ups were observed and were mitigated by propensity score matching. Second-stage cesarean cases occurred predominantly due to arrest of stage, with higher rates of uterine atony, postpartum hemorrhage, hysterotomy extension, and longer procedural times. Longer analgesia duration was associated with increased operating room preparation time, cesarean duration, and neuraxial replacement before procedure. Rates of intraoperative intravenous adjunct use and conversion to general anesthesia were comparable across stages and analgesia duration.</div></div><div><h3>Conclusions</h3><div>After propensity score matching, stage of labor at the time of procedure was not associated with increased intravenous adjunct use or general anesthesia conversion for intrapartum cesareans. Neuraxial anesthesia remains a reliable choice for second-stage cesarean delivery when managed proactively, though prolonged analgesia warrants vigilance for catheter replacement before surgery.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104799"},"PeriodicalIF":2.3,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325910","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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