Mode of anaesthesia for preterm Caesarean delivery: secondary analysis from the Maternal-Fetal Medicine Units Network Caesarean Registry

Butwick, A. J.; El-Sayed, Y. Y.; Blumenfeld, Y. J.; Osmundson, S. S.; Weiniger, C. F.
August 2015
BJA: The British Journal of Anaesthesia;Aug2015, Vol. 115 Issue 2, p267
Academic Journal
journal article
Background: Preterm delivery is often performed by Caesarean section. We investigated modes of anaesthesia and risk factors for general anaesthesia among women undergoing preterm Caesarean delivery. Methods: Women undergoing Caesarean delivery between 24(+0) and 36(+6) weeks' gestation were identified from a multicentre US registry. The mode of anaesthesia was classified as neuraxial anaesthesia (spinal, epidural, or combined spinal and epidural) or general anaesthesia. Logistic regression was used to identify patient characteristic, obstetric, and peripartum risk factors associated with general anaesthesia. Results: Within the study cohort, 11 539 women had preterm Caesarean delivery; 9510 (82.4%) underwent neuraxial anaesthesia and 2029 (17.6%) general anaesthesia. In our multivariate model, African-American race [adjusted odds ratio (aOR)=1.9; 95% confidence interval (CI)=1.7-2.2], Hispanic ethnicity (aOR=1.5; 95% CI=1.2-1.8), other race (aOR=1.4; 95% CI=1.1-1.9), and haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome or eclampsia (aOR=2.8; 95% CI=2.2-3.5) were independently associated with receiving general anaesthesia for preterm Caesarean delivery. Women with an emergency Caesarean delivery indication had the highest odds for general anaesthesia (aOR=3.5; 95% CI=3.1-3.9). For every 1 week decrease in gestational age at delivery, the adjusted odds of general anaesthesia increased by 13%. Conclusions: In our study cohort, nearly one in five women received general anaesthesia for preterm Caesarean delivery. Although potential confounding by unmeasured factors cannot be excluded, our findings suggest that early gestational age at delivery, emergent Caesarean delivery indications, hypertensive disease, and non-Caucasian race or ethnicity are associated with general anaesthesia for preterm Caesarean delivery.


Related Articles

  • Converting to General Anesthesia in a Complex Parturient. Murphy, Michael // International Student Journal of Nurse Anesthesia;Summer2015, Vol. 14 Issue 2, p32 

    No abstract available.

  • Současné postupy v porodnické anestezii II. -- celková anestezie u císaÅ™ského Å™ezu. Bláha, Jan; Nosková, Pavlína; Klozová, Radka; Seidlová, Dagmar; Štourac, Petr; Parízek, Antonín // Anaesthesiology & Intensive Medicine / Anesteziologie a Intenziv;2013, Vol. 24 Issue 3, p186 

    General anaesthesia for Caesarean Section remains the method of choice in life-threatening situations for the mother or foetus. Although meta-analyses of studies comparing neuraxial and general anaesthesia did not find significant differences in maternal mortality or in the influence of...

  • The use of magnesium sulfate in severely preeclamptic patients for emergency cesaren section. Ayazođlu, Tülin Akarsu; Unal, Murat // Anaesthesia, Pain & Intensive Care;Oct-Dec2011, Vol. 15 Issue 3, p178 

    The anaesthetic management in the peripartum period of a pre-eclamptic patient is important. The anesthesiologist must perform a detailed preanesthetic assessment, including a history and physical examination. The morbidity and mortality rates are higher in severe preeclamsia. Magnesium sulfate...

  • Současné postupy v porodnické anestezii III. -- regionální anestezie u císaÅ™ského Å™ezu. Jan, Bláha; Pavlína, Nosková; Radka, Klozová; Dagmar, Seidlová; Petr, Štourač; Antonín, Pařízek // Anaesthesiology & Intensive Medicine / Anesteziologie a Intenziv;2014, Vol. 25 Issue 1, p29 

    Nearly a quarter of all births in the Czech Republic end by caesarean section in the recent years. With the increasing age of mothers, number of comorbidities, deliveries after previous caesarean section and many other causes, it can be assumed that this trend will continue to rise despite all...

  • Preterm birth by vacuum extraction and neonatal outcome: a population-based cohort study. Åberg, Katarina; Norman, Mikael; Ekéus, Cecilia // BMC Pregnancy & Childbirth;2014, Vol. 14 Issue 1, p1 

    Background Very few studies have investigated the neonatal outcomes after vacuum extraction delivery (VE) in the preterm period and the results of these studies are inconclusive. The objective of this study was to describe the use of VE for preterm delivery in Sweden and to compare rates of...

  • Perinatal outcomes in condyloma acuminata pregnancies. Cohen, Eyal; Levy, Amalia; Holcberg, Gershon; Wiznitzer, Arnon; Mazor, Moshe; Sheiner, Eyal // Archives of Gynecology & Obstetrics;Jun2011, Vol. 283 Issue 6, p1269 

    Objective: To investigate pregnancy outcome in patients with condyloma acuminata. Methods: A retrospective cohort study comparing pregnancy outcome of women with and without condyloma acuminata was performed. A sub-group analysis was performed between patients with localized disease ( n = 40),...

  • Risk of peripartum hysterectomy by mode of delivery and prior obstetric history: data from a population-based study. Spiliopoulos, Michail; Kareti, Aparna; Jain, Neetu; Kruse, Lakota; Hanlon, Alex; Dandolu, Vani // Archives of Gynecology & Obstetrics;Jun2011, Vol. 283 Issue 6, p1261 

    Purpose: To provide an estimate of the incidence of peripartum hysterectomy in the state of New Jersey and calculate the effect of mode of delivery and prior obstetric history. Methods: A perinatal-linked dataset provided by the Maternal Child Health Epidemiology Program in the New Jersey...

  • ACOG annual meeting highlights.  // Contemporary OB/GYN;Jul2000, Vol. 45 Issue 7, p143 

    Presents a update on obstetrics and gynecology as of July 2000. Impact of epidural analgesia on labor and delivery; Elective use of cesarean section to prevent complications; Link between hysterectomy and sexual response.

  • Comparison of low dose spinal anesthesia with general anesthesia in pre-eclamptic parturients undergoing emergency cesarean section. Sivevski, Atanas G.; Sholjakova, Marija V.; Kartalov, Andrijan B.; Kuzmanovska, Biljana K.; Durnev, Vesna M. // Anaesthesia, Pain & Intensive Care;Jan-Mar2015, Vol. 19 Issue 1, p37 

    Objectives: Both spinal (SA) and general anesthesia (GA) are commonly used for operative management of pre-eclampsia parturients. Low dose SA is practical with faster onset and with fewer complications. This study aims to compare the effect of low dose SA or GA on neonatal wellbeing for...


Read the Article

Courtesy of

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics