Pub Date : 2025-09-15DOI: 10.1016/j.ijoa.2025.104772
J.T. Le , M. Muravyeva
Congenital central hypoventilation syndrome (CCHS), also known as Ondine’s Curse, is an autonomic disorder resulting in an inadequate respiratory response to hypercapnia and hypoxia, especially during periods of decreased wakefulness. Patients with CCHS are particularly sensitive to the effects of anesthetic medications, with increased risk for intraoperative events including hypotension, bradycardia, and hypoxemia. The current literature on the anesthetic management for patients with CCHS mainly described the use of general anesthesia, with few case reports describing neuraxial anesthesia. To our knowledge, this is the first case describing the anesthetic care for cesarean delivery of a patient with CCHS, with low-dose combined spinal epidural anesthesia. The patient had two previous cesarean deliveries with spinal anesthesia, complicated by hypotension and syncope secondary to autonomic dysfunction and/or neural-mediated syncope. This case highlights low-dose combined spinal epidural as a possible anesthetic approach in patients with CCHS, reducing the risk of hypotension and respiratory depression.
{"title":"Cesarean delivery with low-dose combined spinal epidural in a patient with congenital central hypoventilation syndrome: a case report","authors":"J.T. Le , M. Muravyeva","doi":"10.1016/j.ijoa.2025.104772","DOIUrl":"10.1016/j.ijoa.2025.104772","url":null,"abstract":"<div><div>Congenital central hypoventilation syndrome (CCHS), also known as Ondine’s Curse, is an autonomic disorder resulting in an inadequate respiratory response to hypercapnia and hypoxia, especially during periods of decreased wakefulness. Patients<!--> <!-->with CCHS are particularly sensitive to the effects of anesthetic medications, with increased risk for intraoperative events including hypotension, bradycardia, and hypoxemia. The current literature on the anesthetic management for patients with CCHS mainly described the use of general anesthesia, with few case reports describing neuraxial anesthesia. To our knowledge,<!--> <!-->this is the first case describing the anesthetic care for cesarean delivery of a patient with CCHS,<!--> <!-->with low-dose combined spinal epidural anesthesia. The patient had two previous cesarean deliveries with spinal anesthesia, complicated by hypotension and syncope secondary to autonomic dysfunction and/or neural-mediated syncope. This case highlights low-dose combined spinal epidural as a possible anesthetic approach in patients with CCHS, reducing the risk of hypotension and respiratory depression.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104772"},"PeriodicalIF":2.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091527","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 : 2025-09-14DOI: 10.1016/j.ijoa.2025.104771
Samantha F. Lu , Robert J. McCarthy , Paloma Toledo , Caroline L. Thomas , Ian N. Gaston , Alexander G. Samworth , Pauline E. Ripchik , Mikayla B. Troughton , Carmen E. Lopez , Jessica H. Kruse , Jennifer M. Banayan
{"title":"Corrigendum to “Effect of metoclopramide on gastric volume and nausea and vomiting outcomes in fasted patients undergoing Elective Cesarean delivery: a randomized clinical equivalence trial”. [Int. J. Obstetr. Anesth. 64 (2025) 104754]","authors":"Samantha F. Lu , Robert J. McCarthy , Paloma Toledo , Caroline L. Thomas , Ian N. Gaston , Alexander G. Samworth , Pauline E. Ripchik , Mikayla B. Troughton , Carmen E. Lopez , Jessica H. Kruse , Jennifer M. Banayan","doi":"10.1016/j.ijoa.2025.104771","DOIUrl":"10.1016/j.ijoa.2025.104771","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104771"},"PeriodicalIF":2.3,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145057086","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 : 2025-09-06DOI: 10.1016/j.ijoa.2025.104769
R. McCarthy , M. Glynn , R. Kearsley , R. Drew , M. Cotter , C. Murphy
{"title":"In response to “Maternal physiological parameters and routine laboratory tests to screen for maternal sepsis: an observational cohort study” - Neutrophil-to-lymphocyte ratio as a promising cost-effective adjunct in the early detection of maternal sepsis","authors":"R. McCarthy , M. Glynn , R. Kearsley , R. Drew , M. Cotter , C. Murphy","doi":"10.1016/j.ijoa.2025.104769","DOIUrl":"10.1016/j.ijoa.2025.104769","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104769"},"PeriodicalIF":2.3,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091663","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 : 2025-09-05DOI: 10.1016/j.ijoa.2025.104768
M.J. Khan , J. Hassan , A. Karmakar , M. Khan , C.T. Dean , B.M. Scavone , N.M. Cole
Background
Closed-loop vasopressor systems automate vasopressor administration using real-time hemodynamic biofeedback; clinical equipoise exists between closed-loop vasopressor systems and manual vasopressor titration. This review evaluates the performance and hemodynamic outcomes of closed-loop vasopressor systems vs. manual titration in cesarean delivery under spinal anesthesia.
Methods
Included studies compared closed-loop vasopressor systems with manual vasopressor administration for spinal hypotension in cesarean delivery. Primary outcomes were closed-loop vasopressor systems performance and hemodynamic measures. Performance was assessed with median performance error, median absolute performance error, wobble (intraindividual variation in performance error) and divergence (performance error over time). Meta-analyses were conducted for RCTs and observational studies separately. Risk of bias was assessed using Cochrane methodology. Data were reported as risk ratio (RR) or mean difference (MD) with 95 % confidence intervals (CI).
Results
Seven studies (n = 864) were included. In three RCTs (n = 654), wobble (MD −0.66 %; 95 % CI −1.29 to −0.02; P = 0.04), hypotension incidence (RR 0.67; 95 % CI 0.55 to 0.82; P < 0.01), and the highest and lowest systolic blood pressures values (MD −4.05 mmHg; 95 % CI −7.03 to −1.06; P < 0.01 and MD 5.39 mmHg; 95 % CI 2.17 to 8.60; P < 0.01, respectively) were minimized with closed-loop vasopressor systems, but no significant differences were observed in other primary outcomes. Maternal nausea was reduced with closed-loop vasopressor systems (RR 0.47; 95 % CI 0.26 to 0.85; P = 0.01; moderate quality of evidence). In four observational studies (n = 210), the pooled values for median absolute performance error, wobble, divergence of the system, hypotension incidence, highest and lowest systolic blood pressures, highest and lowest heart rates, total fluids, total phenylephrine and ephedrine dosages were statistically significant. Risk of bias was low to moderate for all studies.
Conclusion
Closed-loop vasopressor systems may improve systolic blood pressure fluctuations in cesarean deliveries with spinal anesthesia compared to manually adjusted vasopressor dosing; however, more high-quality evidence is needed.
{"title":"Closed-loop vasopressor systems for hemodynamic stability during cesarean delivery and maternal and neonatal outcomes: a systematic review and meta-analysis","authors":"M.J. Khan , J. Hassan , A. Karmakar , M. Khan , C.T. Dean , B.M. Scavone , N.M. Cole","doi":"10.1016/j.ijoa.2025.104768","DOIUrl":"10.1016/j.ijoa.2025.104768","url":null,"abstract":"<div><h3>Background</h3><div>Closed-loop vasopressor systems automate vasopressor administration using real-time hemodynamic biofeedback; clinical equipoise exists between closed-loop vasopressor systems and manual vasopressor titration. This review evaluates the performance and hemodynamic outcomes of closed-loop vasopressor systems vs. manual titration in cesarean delivery under spinal anesthesia.</div></div><div><h3>Methods</h3><div>Included studies compared closed-loop vasopressor systems with manual vasopressor administration for spinal hypotension in cesarean delivery. Primary outcomes were closed-loop vasopressor systems performance and hemodynamic measures. Performance was assessed with median performance error, median absolute performance error, wobble (intraindividual variation in performance error) and divergence (performance error over time). Meta-analyses were conducted for RCTs and observational studies separately. Risk of bias was assessed using Cochrane methodology. Data were reported as risk ratio (RR) or mean difference (MD) with 95 % confidence intervals (CI).</div></div><div><h3>Results</h3><div>Seven studies (n = 864) were included. In three RCTs (n = 654), wobble (MD −0.66 %; 95 % CI −1.29 to −0.02; <em>P</em> = 0.04), hypotension incidence (RR 0.67; 95 % CI 0.55 to 0.82; <em>P</em> < 0.01), and the highest and lowest systolic blood pressures values (MD −4.05 mmHg; 95 % CI −7.03 to −1.06; <em>P</em> < 0.01 and MD 5.39 mmHg; 95 % CI 2.17 to 8.60; <em>P</em> < 0.01, respectively) were minimized with closed-loop vasopressor systems, but no significant differences were observed in other primary outcomes. Maternal nausea was reduced with closed-loop vasopressor systems (RR 0.47; 95 % CI 0.26 to 0.85; <em>P</em> = 0.01; moderate quality of evidence). In four observational studies (n = 210), the pooled values for median absolute performance error, wobble, divergence of the system, hypotension incidence, highest and lowest systolic blood pressures, highest and lowest heart rates, total fluids, total phenylephrine and ephedrine dosages were statistically significant. Risk of bias was low to moderate for all studies.</div></div><div><h3>Conclusion</h3><div>Closed-loop vasopressor systems may improve systolic blood pressure fluctuations in cesarean deliveries with spinal anesthesia compared to manually adjusted vasopressor dosing; however, more high-quality evidence is needed.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104768"},"PeriodicalIF":2.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145117983","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 : 2025-09-05DOI: 10.1016/j.ijoa.2025.104770
J. Vargas , A. Hirano , C. Arzola , S.R. Hobson , Y. Kunpalin , K. Downey , M. Balki
Background
Although combined spinal epidural (CSE) analgesia is an effective technique for labor analgesia, concerns regarding fetal bradycardia still remain. Increased vascular resistance of the uterine (UtA) and/or umbilical arteries (UmA) after CSE could explain the reported occurrence of fetal bradycardia. The aim of this study was to assess the changes in the resistance of UmA and UtA before and after initiation of CSE labor analgesia using ultrasound Doppler pulsatility index (PI).
Methods
This was a prospective, observational study in singleton, full-term laboring participants. Doppler ultrasound PI of the UtA and UmA were obtained before and after CSE at 10 and 30 min. The primary outcome was PI at 10 min. The differences in indices were analyzed using paired t-tests or Wilcoxon signed-rank tests, and mixed models were used in the exploratory analyses to assess changes over time.
Results
Data were analyzed for 30 participants. Compared to baseline, there was a significant increase in mean UtA PI (Δ 27 %, P = 0.029) at 10 min, however no significant difference was observed in the UmA PI. UtA PI showed a significant increase over time (coefficient 0.05, P = 0.002), while no changes were observed in UmA PI or fetal heart rate.
Conclusion
Our study suggests that CSE for labor analgesia may be associated with a discrete increase in maternal UtA resistance, however, these changes are not reflected in UmA resistance in the fetus, providing reassurance that CSE with low-dose local anesthetic is a safe analgesic technique in labor.
{"title":"Changes in velocimetric indices of uterine and umbilical arteries before and after combined spinal epidural analgesia in laboring women: a prospective cohort study","authors":"J. Vargas , A. Hirano , C. Arzola , S.R. Hobson , Y. Kunpalin , K. Downey , M. Balki","doi":"10.1016/j.ijoa.2025.104770","DOIUrl":"10.1016/j.ijoa.2025.104770","url":null,"abstract":"<div><h3>Background</h3><div>Although combined spinal epidural (CSE) analgesia is an effective technique for labor analgesia, concerns regarding fetal bradycardia still remain. Increased vascular resistance of the uterine (UtA) and/or umbilical arteries (UmA) after CSE could explain the reported occurrence of fetal bradycardia. The aim of this study was to assess the changes in the resistance of UmA and UtA before and after initiation of CSE labor analgesia using ultrasound Doppler pulsatility index (PI).</div></div><div><h3>Methods</h3><div>This was a prospective, observational study in singleton, full-term laboring participants. Doppler ultrasound PI of the UtA and UmA were obtained before and after CSE at 10 and 30 min. The primary outcome was PI at 10 min. The differences in indices were analyzed using paired t-tests or<!--> <!-->Wilcoxon signed-rank tests, and mixed models were used in the exploratory analyses to assess changes over time.</div></div><div><h3>Results</h3><div>Data were analyzed for 30 participants. Compared to baseline, there was a significant increase in mean UtA PI (Δ 27 %, <em>P</em> = 0.029) at 10 min, however no significant difference was observed in the UmA PI. UtA PI showed a significant increase over time (coefficient 0.05, <em>P</em> = 0.002), while no changes were observed in UmA PI or fetal heart rate.</div></div><div><h3>Conclusion</h3><div>Our study suggests that CSE for labor analgesia may be associated with a discrete increase in maternal UtA resistance, however, these changes are not reflected in UmA resistance in the fetus, providing reassurance that CSE with low-dose local anesthetic is a safe analgesic technique in labor.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104770"},"PeriodicalIF":2.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044260","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 : 2025-09-04DOI: 10.1016/j.ijoa.2025.104767
K. Sassi, J. Debiol, S. Scache, V. Minville
Background
Epidural blood patch remains the gold standard for treating postdural puncture headache following unintentional dural puncture during labor epidural analgesia. However, epidural blood patch may fail in 17–28 % of cases, necessitating repeat procedures. Factors predicting epidural blood patch failure remain poorly understood, limiting the ability to optimize treatment strategies. We aimed to identify independent predictors of repeat epidural blood patch following postdural puncture headache.
Methods
We conducted a retrospective observational study at a tertiary maternity center from January 2014 to December 2024. All obstetric patients receiving an epidural blood patch following labor epidural analgesia were included. Demographic, clinical, and procedural variables were analyzed to identify independent predictors of repeat epidural blood patch using multivariable logistic regression. The primary outcome was the need for more than one epidural blood patch to achieve symptom resolution.
Results
Among 142 included patients, 39 (27.5 %) required repeat epidural blood patch procedures. Multivariable analysis identified two independent predictors of repeat EBP: earlier timing of first blood patch (OR 0.441 per day delay, 95 % CI 0.270 to 0.721, P = 0.001) and shallower epidural space depth (OR 0.687 per cm, 95 % CI 0.493 to 0.958, P = 0.027). Sensitivity analysis confirmed that EBP performed within 24 h (OR 4.740) and within 48 h (OR 3.689) was associated with significantly higher failure rates. Patients requiring repeat procedures had significantly longer hospital stays (median 5 vs. 4 days, P < 0.001).
Conclusions
Early epidural blood patch administration (≤48 h) and shallow epidural space depth were independently associated with treatment failure. These associations may reflect confounding by indication and require further validation.
背景：硬膜外血贴仍然是治疗分娩过程中意外硬膜穿刺后硬膜后头痛的金标准。然而，硬膜外补血可能在17 - 28%的病例中失败，需要重复手术。预测硬膜外血贴失败的因素仍然知之甚少，限制了优化治疗策略的能力。我们的目的是确定独立的预测因素重复硬膜外血贴片后硬脊膜穿刺头痛。方法于2014年1月至2024年12月在某三级妇产中心进行回顾性观察研究。所有在分娩后硬膜外镇痛后接受硬膜外血液贴片的产科患者均被纳入研究。采用多变量logistic回归分析人口统计学、临床和程序变量，以确定重复硬膜外血贴片的独立预测因素。主要结果是需要一个以上的硬膜外血液贴片来达到症状缓解。结果142例患者中，39例（27.5%）需要重复硬膜外补血。多变量分析确定了重复EBP的两个独立预测因素：第一次补血时间较早（OR 0.441 / d, 95% CI 0.270 ~ 0.721, P = 0.001）和硬膜外腔深度较浅（OR 0.687 / cm, 95% CI 0.493 ~ 0.958, P = 0.027）。敏感性分析证实，24小时内（OR 4.740）和48小时内（OR 3.689）进行EBP的失败率明显较高。需要重复手术的患者住院时间明显延长（中位5天vs. 4天，P < 0.001）。结论早期硬膜外补血（≤48 h）和浅硬膜外间隙深度与治疗失败独立相关。这些关联可能反映了适应症的混淆，需要进一步验证。
{"title":"Predictors of repeat epidural blood patch for postdural puncture headache after labor epidural analgesia: a single-center retrospective cohort study (2014–2024)","authors":"K. Sassi, J. Debiol, S. Scache, V. Minville","doi":"10.1016/j.ijoa.2025.104767","DOIUrl":"10.1016/j.ijoa.2025.104767","url":null,"abstract":"<div><h3>Background</h3><div>Epidural blood patch remains the gold standard for treating postdural puncture headache following unintentional dural puncture during labor epidural analgesia. However, epidural blood patch may fail in 17–28 % of cases, necessitating repeat procedures. Factors predicting epidural blood patch failure remain poorly understood, limiting the ability to optimize treatment strategies. We aimed to identify independent predictors of repeat epidural blood patch following postdural puncture headache.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study at a tertiary maternity center from January 2014 to December 2024. All obstetric patients receiving an epidural blood patch following labor epidural analgesia were included. Demographic, clinical, and procedural variables were analyzed to identify independent predictors of repeat epidural blood patch using multivariable logistic regression. The primary outcome was the need for more than one epidural blood patch to achieve symptom resolution.</div></div><div><h3>Results</h3><div>Among 142 included patients, 39 (27.5 %) required repeat epidural blood patch procedures. Multivariable analysis identified two independent predictors of repeat EBP: earlier timing of first blood patch (OR 0.441 per day delay, 95 % CI 0.270 to 0.721, <em>P</em> = 0.001) and shallower epidural space depth (OR 0.687 per cm, 95 % CI 0.493 to 0.958, <em>P</em> = 0.027). Sensitivity analysis confirmed that EBP performed within 24 h (OR 4.740) and within 48 h (OR 3.689) was associated with significantly higher failure rates. Patients requiring repeat procedures had significantly longer hospital stays (median 5 vs. 4 days, <em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Early epidural blood patch administration (≤48 h) and shallow epidural space depth were independently associated with treatment failure. These associations may reflect confounding by indication and require further validation.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104767"},"PeriodicalIF":2.3,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145094880","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 : 2025-09-01DOI: 10.1016/j.ijoa.2025.104766
E Sanderson , T Stegeman , J Elhindi , L Cope , JS Dieleman , D Pasupathy , D Tanous , J Brown
Background
Maternal cardiovascular disease (CVD) is a leading cause of maternal mortality. Data on anaesthetic management in patients with CVD is limited.
Methods
This ten-year retrospective cohort study of 508 pregnancies in women with CVD, stratified by modified World Health Organization (mWHO) risk category, compared lowrisk (mWHO I-II) (n = 323) and high-risk (mWHO II to III-IV) (n = 185) groups to a control obstetric population (n = 55,153). The primary outcomes were maternal mortality and cardiac failure, secondary outcomes included maternal, obstetric, major anaesthetic, and neonatal complications.
Results
There were no maternal deaths, 3 % of patients developed cardiac failure. High risk patents were more likely to deliver by caesarean delivery (CD) than controls (P < 0.01), but low risk were not (P = 1.0). There was no difference in postpartum haemorrhage rates between groups (P = 0.91). Rates of preterm birth, low Apgar score, and stillbirth were higher in high-risk patients than low-risk and control groups (P < 0.01, P = 0.01, P = 0.02, respectively). Maternal cardiac disease influenced decision for preterm birth in 15 %. There was one neonatal death (low-risk group, 0.3 %), comparable to the control population (0.3 %). Labor epidural analgesia was the predominant mode of analgesia for vaginal deliveries in low- and high-risk groups. The most frequent modes of anaesthesia for CD were spinal anaesthesia (61 %) in low-risk and combined spinal epidural (31 %) in high-risk patients. Major anaesthetic complications were rare (0.2 %).
Conclusions
This study of peripartum management and outcomes in women with mWHO I-IV cardiovascular risk demonstrated low levels of maternal mortality and morbidity, but increased risk of several adverse outcomes in high-risk CVD. Clinicians should anticipate the risk of preterm birth and need for specialised care in high-risk CVD patients.
{"title":"Peripartum management and outcomes of cardiovascular disease in pregnancy: a single-centre retrospective cohort study from Australia (2012–2021)","authors":"E Sanderson , T Stegeman , J Elhindi , L Cope , JS Dieleman , D Pasupathy , D Tanous , J Brown","doi":"10.1016/j.ijoa.2025.104766","DOIUrl":"10.1016/j.ijoa.2025.104766","url":null,"abstract":"<div><h3>Background</h3><div>Maternal cardiovascular disease (CVD) is a leading cause of maternal mortality. Data on anaesthetic management in patients with CVD is limited.</div></div><div><h3>Methods</h3><div>This ten-year retrospective cohort study of 508 pregnancies in women with CVD, stratified by modified World Health Organization (mWHO) risk category, compared lowrisk (mWHO I-II) (n = 323) and high-risk (mWHO II to III-IV) (n = 185) groups to a control obstetric population (n = 55,153). The primary outcomes were maternal mortality and cardiac failure, secondary outcomes included maternal, obstetric, major anaesthetic, and neonatal complications.</div></div><div><h3>Results</h3><div>There were no maternal deaths, 3 % of patients developed cardiac failure. High risk patents were more likely to deliver by caesarean delivery (CD) than controls (<em>P</em> < 0.01), but low risk were not (<em>P</em> = 1.0). There was no difference in postpartum haemorrhage rates between groups (<em>P</em> = 0.91). Rates of preterm birth, low Apgar score, and stillbirth were higher in high-risk patients than low-risk and control groups (<em>P</em> < 0.01, <em>P</em> = 0.01, <em>P</em> = 0.02, respectively). Maternal cardiac disease influenced decision for preterm birth in 15 %. There was one neonatal death (low-risk group, 0.3 %), comparable to the control population (0.3 %). Labor epidural analgesia was the predominant mode of analgesia for vaginal deliveries in low- and high-risk groups. The most frequent modes of anaesthesia for CD were spinal anaesthesia (61 %) in low-risk and combined spinal epidural (31 %) in high-risk patients. Major anaesthetic complications were rare (0.2 %).</div></div><div><h3>Conclusions</h3><div>This study of peripartum management and outcomes in women with mWHO I-IV cardiovascular risk demonstrated low levels of maternal mortality and morbidity, but increased risk of several adverse outcomes in high-risk CVD. Clinicians should anticipate the risk of preterm birth and need for specialised care in high-risk CVD patients.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104766"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145003661","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 : 2025-08-29DOI: 10.1016/j.ijoa.2025.104760
Briana Clifton , Yunseo Linda Park , Rida Ashraf , Andrea Gomez Sanchez , Robert J. McCarthy , Mark D. Neuman , Grace Lim
Introduction
Patient priorities for anesthesia during a cesarean delivery are not well defined. Previous studies have explored patient preferences for cesarean delivery anesthesia but have not evaluated patient-centered endpoints unrelated to the physical experience which are known to be important to patients’ birth experiences, such as being treated with respect, communication, and emotional support. The purpose of this study was to compare patients’ and providers’ priorities for cesarean delivery anesthesia care.
Methods
This prospective cross-sectional quantitative survey study included patients with recent cesarean deliveries and clinical providers who provide clinical care for cesarean deliveries. Eleven patient-centered factor related to cesarean delivery anesthesia experience were identified based on previously reported findings and results of semi-structured interviews. Participants then completed a forced ranking survey for these 11 factor, ranked in order from most important to least important aspect of cesarean anesthesia care. They also ranked most desired to least desired anesthesia side effects (e.g., pruritus, nausea, pain). Participants also rated their perceived importance of the factor ranked highest and lowest on a 0–10 numeric rating scale (0 = not important at all and 10 = most important imaginable). Rankings from patient and provider groups were compared using Plackett-Luce method using tree-based recursive partitioning.
Results
One hundred forty-four respondents (127 patients, 17 providers) were included in the analysis. “Physical safety of the baby” was ranked highest among patients and was higher than the rank assigned by providers (P < 0.001). Although mothers with vs. without self-reported birth trauma each highly prioritized safety of baby, the relative priority placed on this factor was higher among mothers with self-reported birth trauma. For anesthesia-related side effects, patients and providers agreed that memory loss, spinal headaches, and pain or discomfort during surgery, represented high-priority concerns to avoid; drowsiness, shivering, and pruritus were considered lower-priority. There were ranking differences between in person and digital recruited patients.
Conclusion
Patients and providers have discordant views on priorities during cesarean delivery, and similar views on priorities for anesthesia-related side effects. A self-reported history of birth trauma, but not pain during cesarean delivery, is associated with high prioritization of physical safety of mother and baby over other cesarean experience priorities. Future clinical care improvements and research are needed to help patients and providers balance the outcomes most important to patients during and after cesarean delivery.
{"title":"A comparative study of patient and provider priorities for cesarean delivery anesthesia care","authors":"Briana Clifton , Yunseo Linda Park , Rida Ashraf , Andrea Gomez Sanchez , Robert J. McCarthy , Mark D. Neuman , Grace Lim","doi":"10.1016/j.ijoa.2025.104760","DOIUrl":"10.1016/j.ijoa.2025.104760","url":null,"abstract":"<div><h3>Introduction</h3><div>Patient priorities for anesthesia during a cesarean delivery are not well defined. Previous studies have explored patient preferences for cesarean delivery anesthesia but have not evaluated patient-centered endpoints unrelated to the physical experience which are known to be important to patients’ birth experiences, such as being treated with respect, communication, and emotional support. The purpose of this study was to compare patients’ and providers’ priorities for cesarean delivery anesthesia care.</div></div><div><h3>Methods</h3><div>This prospective cross-sectional quantitative survey study included patients with recent cesarean deliveries and clinical providers who provide clinical care for cesarean deliveries. Eleven patient-centered factor related to cesarean delivery anesthesia experience were identified based on previously reported findings and results of semi-structured interviews. Participants then completed a forced ranking survey for these 11 factor, ranked in order from most important to least important aspect of cesarean anesthesia care. They also ranked most desired to least desired anesthesia side effects (e.g., pruritus, nausea, pain). Participants also rated their perceived importance of the factor ranked highest and lowest on a 0–10 numeric rating scale (0 = not important at all and 10 = most important imaginable). Rankings from patient and provider groups were compared using Plackett-Luce method using tree-based recursive partitioning.</div></div><div><h3>Results</h3><div>One hundred forty-four respondents (127 patients, 17 providers) were included in the analysis. “Physical safety of the baby” was ranked highest among patients and was higher than the rank assigned by providers (<em>P</em> < 0.001). Although mothers with vs. without self-reported birth trauma each highly prioritized safety of baby, the relative priority placed on this factor was higher among mothers with self-reported birth trauma. For anesthesia-related side effects, patients and providers agreed that memory loss, spinal headaches, and pain or discomfort during surgery, represented high-priority concerns to avoid; drowsiness, shivering, and pruritus were considered lower-priority. There were ranking differences between in person and digital recruited patients.</div></div><div><h3>Conclusion</h3><div>Patients and providers have discordant views on priorities during cesarean delivery, and similar views on priorities for anesthesia-related side effects. A self-reported history of birth trauma, but not pain during cesarean delivery, is associated with high prioritization of physical safety of mother and baby over other cesarean experience priorities. Future clinical care improvements and research are needed to help patients and providers balance the outcomes most important to patients during and after cesarean delivery.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104760"},"PeriodicalIF":2.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145003660","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 : 2025-08-26DOI: 10.1016/j.ijoa.2025.104765
B.M. Togioka , S.C. Reale , T. Klumpner , M.F. Aziz , M.R. Mathis
{"title":"The multicenter perioperative outcomes group (MPOG) learning health system: a model for promoting evidence-based peripartum care","authors":"B.M. Togioka , S.C. Reale , T. Klumpner , M.F. Aziz , M.R. Mathis","doi":"10.1016/j.ijoa.2025.104765","DOIUrl":"10.1016/j.ijoa.2025.104765","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104765"},"PeriodicalIF":2.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144996477","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 : 2025-08-26DOI: 10.1016/j.ijoa.2025.104764
P.T. Vozzo, B. Waldman, R.M. Smiley
Background
For emergent intrapartum cesarean delivery, epidural catheters are dosed as quickly as possible with ∼20 mL of local anesthetic. At our institution, emergency local anesthetics are drawn into two 10 mL syringes, as opposed to a single 20 mL syringe, due to the belief that it is faster to inject medication via two 10 mL syringes. However, it is unclear if using two 10 mL syringes is actually faster. Our hypothesis was that injecting 20 mL through an epidural catheter using one 20 mL syringe is faster than injecting 20 mL using two 10 mL syringes.
Methods
In this study, 20 anesthesia professionals were timed while injecting 20 mL of water (simulating a local anesthetic solution) through an epidural catheter using each method, a 20 mL syringe and two 10 mL syringes. Participants were instructed to inject as if they were dosing an epidural for an emergent cesarean delivery. Analysis was by paired-t-test.
Results
The mean time of injection was 41.77 seconds ± 11.16 with the 20 mL syringe and 43.32 seconds ± 7.40 with the two 10 mL syringes (P = 0.338). There was, however, a statistically significant difference among men injecting through one 20 mL vs. two 10 mL syringes (37.81 seconds ± 11.22 vs. 41.52 seconds ± 8.10, respectively; P = 0.028), but not among women.
Conclusions
There was no difference in injection speed between one 20 mL syringe and two 10 mL syringes, suggesting that anesthesiologists can use whatever size is most comfortable for them.
{"title":"Ten plus ten equals twenty: a prospective crossover study evaluating syringe size and speed of epidural injection","authors":"P.T. Vozzo, B. Waldman, R.M. Smiley","doi":"10.1016/j.ijoa.2025.104764","DOIUrl":"10.1016/j.ijoa.2025.104764","url":null,"abstract":"<div><h3>Background</h3><div>For emergent intrapartum cesarean delivery, epidural catheters are dosed as quickly as possible with ∼20 mL of local anesthetic. At our institution, emergency local anesthetics are drawn into two 10 mL syringes, as opposed to a single 20 mL syringe, due to the belief that it is faster to inject medication via two 10 mL syringes. However, it is unclear if using two 10 mL syringes is actually faster. Our hypothesis was that injecting 20 mL through an epidural catheter using one 20 mL syringe is faster than injecting 20 mL using two 10 mL syringes.</div></div><div><h3>Methods</h3><div>In this study, 20 anesthesia professionals were timed while injecting 20 mL of water (simulating a local anesthetic solution) through an epidural catheter using each method, a 20 mL syringe and two 10 mL syringes. Participants were instructed to inject as if they were dosing an epidural for an emergent cesarean delivery. Analysis was by paired-<em>t</em>-test.</div></div><div><h3>Results</h3><div>The mean time of injection was 41.77 seconds ± 11.16 with the 20 mL syringe and 43.32 seconds ± 7.40 with the two 10 mL syringes (<em>P</em> = 0.338). There was, however, a statistically significant difference among men injecting through one 20 mL vs. two 10 mL syringes (37.81 seconds ± 11.22 vs. 41.52 seconds ± 8.10, respectively; <em>P</em> = 0.028), but not among women.</div></div><div><h3>Conclusions</h3><div>There was no difference in injection speed between one 20 mL syringe and two 10 mL syringes, suggesting that anesthesiologists can use whatever size is most comfortable for them.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104764"},"PeriodicalIF":2.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144920167","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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