International journal of obstetric anesthesia最新文献

{"title":"The effect of preoperative carbohydrate loading on patients’ anxiety prior to elective caesarean delivery: a randomized controlled trial","authors":"N. Adhithya ,&nbsp;R. Sarna ,&nbsp;V. Ashok ,&nbsp;D. Jain ,&nbsp;R. Chauhan ,&nbsp;A. Arora","doi":"10.1016/j.ijoa.2025.104727","DOIUrl":"10.1016/j.ijoa.2025.104727","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative oral carbohydrate loading prior to elective caesarean delivery has been proposed to enhance recovery after surgery. However, its effect on patients’ preoperative anxiety remains uncertain. This study was, hence, conducted to evaluate the anxiolytic effect of oral complex carbohydrate drink in patients undergoing elective caesarean delivery. We hypothesised that patients who received preoperative oral carbohydrate loading would be less anxious before elective caesarean delivery.</div></div><div><h3>Method</h3><div>Patients undergoing elective caesarean delivery were randomized into two groups. The carbohydrate group (n=50) received 300 mL of iso-osmolar carbohydrate drink the night before surgery and two hours prior to surgery and the control group (n=50) received the same volume of regular water at the same time points. The primary outcome was preoperative anxiety, measured using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Maternal hunger, thirst and nausea, maternal and neonatal blood glucose levels, maternal urinary ketones and postoperative quality of recovery were the secondary objectives.</div></div><div><h3>Results</h3><div>The mean ± standard devation APAIS score before surgery were lower in the carbohydrate group compared to the control group, and the difference was statistically significant (4.56 ± 1.21 vs. 6.36 ± 1.55, mean difference −1.80; 95% CI −2.35 to −1.25; <em>P=</em>0.005). The patients in the carbohydrate group were significantly less hungry and thirsty compared to those in the control group, and had a lower incidence of urinary ketosis and a significantly higher quality of recovery on the first postoperative day.</div></div><div><h3>Conclusion</h3><div>Oral carbohydrate loading reduces preoperative anxiety in patients scheduled for elective caesarean delivery.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104727"},"PeriodicalIF":2.6,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144656909","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}

{"title":"In defence of lateral tilt – a response to “Neonatal acid-base status before and after discontinuing routine left uterine displacement for elective cesarean delivery: a retrospective cohort study (2014–2017)”","authors":"J.H. Bamber,&nbsp;H. Beard","doi":"10.1016/j.ijoa.2025.104715","DOIUrl":"10.1016/j.ijoa.2025.104715","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104715"},"PeriodicalIF":2.6,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534410","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}

{"title":"Science at risk, women at risk: the French College of Anaesthesia and Resuscitation in Obstetrics' (CARO) perspective in today’s world","authors":"E. Morau ,&nbsp;S. Paquin ,&nbsp;A.S. Bouthors ,&nbsp;L. Bouvet","doi":"10.1016/j.ijoa.2025.104713","DOIUrl":"10.1016/j.ijoa.2025.104713","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104713"},"PeriodicalIF":2.6,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534409","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}

{"title":"Calcium as a uterotonic: cheap, available, and (maybe) effective?","authors":"J.R. Ansari ,&nbsp;R.M. Smiley","doi":"10.1016/j.ijoa.2025.104711","DOIUrl":"10.1016/j.ijoa.2025.104711","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104711"},"PeriodicalIF":2.6,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491168","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}

{"title":"Timing matters: expanding the role of intravenous dexamethasone in caesarean delivery. A letter to the Editor","authors":"S Craig ,&nbsp;R Craig","doi":"10.1016/j.ijoa.2025.104712","DOIUrl":"10.1016/j.ijoa.2025.104712","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104712"},"PeriodicalIF":2.6,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482433","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}

{"title":"Obstetric anaesthesia quality metrics: local implementation of data utilisation in the United Kingdom","authors":"L. Parker,&nbsp;N. Richards","doi":"10.1016/j.ijoa.2025.104708","DOIUrl":"10.1016/j.ijoa.2025.104708","url":null,"abstract":"<div><div>Local data collection and analysis are acknowledged as common barriers to generation of, and benchmarking against clinical outcome standards in obstetric anaesthesia. We present a replicable model for departmental data collection, processing and visualisation, in the form of a data dashboard. The dashboard has enabled contemporaneous data analysis, leading to real clinical and organisational improvements. By using widely available software and expertise, we present a replicable model, which if adopted at other centres would improve local ownership over obstetric anaesthetic data and provide service insights. We believe that this represents an important step towards national data collection projects in obstetric anaesthesia.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104708"},"PeriodicalIF":2.6,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605131","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}

{"title":"Pain severity during infiltration of local anesthesia before spinal anesthesia as a predictor of post-cesarean pain and Obstetric Quality-of-Recovery scores (ObsQoR-11): a prospective observational study","authors":"C.P. McKenzie ,&nbsp;E. Dengler ,&nbsp;C. Hood ,&nbsp;W. Hart ,&nbsp;J. Swengel ,&nbsp;J. Gue ,&nbsp;X. An ,&nbsp;L. Straube ,&nbsp;M. Sidani ,&nbsp;B. Cobb","doi":"10.1016/j.ijoa.2025.104709","DOIUrl":"10.1016/j.ijoa.2025.104709","url":null,"abstract":"<div><h3>Background</h3><div>Pain during infiltration of local anesthesia (ILA) before spinal anesthesia is a clinical measure shown to predict post-cesarean pain. We evaluated ILA as a predictor of post-cesarean pain and functional recovery.</div></div><div><h3>Methods</h3><div>Patients undergoing cesarean delivery with neuraxial anesthesia were recruited. Pain during ILA (lidocaine 1% 3 mL) was assessed with numerical rating scale (NRS; 0–100). At 24 hours postpartum, six NRS pain scores (average and peak pain at rest, movement, and uterine cramping), ObsQoR-11 and global health rating were recorded. Outcome data compared three groups according to pain during ILA: mild (≤30), moderate (31–69), and severe (≥70). Principal component analysis was used to determine the number of effective independent tests and <em>P</em> value thresholds (resulting in significant <em>P</em> &lt;0.017 for primary outcomes and <em>P</em> &lt;0.013 for other outcomes).</div></div><div><h3>Results</h3><div>Of 114 participants, 83 (72.8%) had mild ILA, 24 (21.1%) had moderate ILA, and 7 (6.1%) had severe ILA. Median rest pain was 20.0 (95% CI 10.0 to 20.0) in mild ILA group, 35 (95% CI 20.0 to 50.0) in moderate ILA group, and 45.0 (95% CI 30.0 to 60.0) in severe ILA group (<em>P</em> &lt;0.001). Median ObsQoR-11 score was not significantly different between groups (90.0 (95% CI 83.0 to 92.0), 74.0 (95% CI 65.0 to 79.0), and 88.0 (95% CI 58.0 to 90.0), respectively; <em>P</em> = 0.021). Median global health rating at 24 hours was 70.0 (95% CI 70.0 to 73.0), 60.0 (95% CI 50.0 to 67.5), and 70.0 (95% CI 40.0 to 80.0), respectively (<em>P</em> =0.010).</div></div><div><h3>Discussion</h3><div>Our findings suggest that pain during ILA may serve as a clinical predictor of post-cesarean pain; however, it was not associated with lower ObsQoR-11 scores.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104709"},"PeriodicalIF":2.6,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605129","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}

{"title":"Incidence, treatment and outcomes of postpartum haemorrhage among women admitted at a large regional referral hospital in eastern Uganda: a one-year prospective observational study","authors":"F. Bulamba ,&nbsp;T. Stephens ,&nbsp;A. Hewitt-Smith ,&nbsp;T.E.F. Abbott ,&nbsp;A. Patel ,&nbsp;K. Mugabe ,&nbsp;M.W. Musaba ,&nbsp;J. Nakibuule ,&nbsp;J. Khanyalano ,&nbsp;H.A. Maiga ,&nbsp;L. Nandyose ,&nbsp;M. Kabaleta ,&nbsp;W. Weere ,&nbsp;C. Mugume ,&nbsp;J. Nanimambi ,&nbsp;M. Sejja ,&nbsp;Rupert M. Pearse","doi":"10.1016/j.ijoa.2025.104707","DOIUrl":"10.1016/j.ijoa.2025.104707","url":null,"abstract":"<div><h3>Background</h3><div>Postpartum haemorrhage (PPH) is the leading cause of maternal mortality in Africa. We studied the incidence, treatment and outcomes of PPH in a large referral hospital in eastern Uganda.</div></div><div><h3>Methods</h3><div>This was a prospective observational study including women admitted to a referral hospital for obstetric care, with in-hospital PPH as the primary outcome and in-hospital mortality as secondary outcome. Data were collected through direct observation on 166 randomly selected days. Multivariable analysis using logistic regression was conducted to determine risk factors for PPH.</div></div><div><h3>Results</h3><div>We recruited 22.0% (2,358/10,842) of all women delivering at the hospital from February 2021 to March 2022; PPH rate was 7.1% (167/2,358) and was associated with greater maternal mortality (4/167 (2.4%) with PPH vs. 2/2,191 (0.1%) without PPH; OR 26.9 [4.9–147.9]; <em>P</em> &lt;0.0001). In multivariable analysis, preeclampsia (OR 2.25 [1.1–4.6]; <em>P</em> = 0.027) and twin pregnancy (OR 3.2 [1.7–6.2]; <em>P</em> &lt;0.001) were associated with increased risk of PPH while caesarean delivery (OR 0.5 [0.3–09]; <em>P</em> = 0.009) and delivery between 4–10 pm (OR 0.6 [0.4–0.9]; <em>P</em> = 0.032) were associated with a reduced risk. There were 448 women (including 281 delivered elsewhere) treated for PPH; 3.3% were treated by an obstetrician at the bedside, 44.0% could have immediately received blood and 47.0% tranexamic acid if needed.</div></div><div><h3>Conclusions</h3><div>One in 14 women delivered at a large Ugandan hospital developed PPH. Rates of PPH and death are far higher than in high-income countries. Our findings highlight staffing shortages and supply chain failures that impact the management of PPH.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104707"},"PeriodicalIF":2.6,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605130","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}

{"title":"Femoral artery Doppler as a novel predictor of spinal hypotension in elective cesarean delivery cases: a prospective observational study","authors":"M.A. Helmy ,&nbsp;K.A. Helmy ,&nbsp;R.A. Kaddah ,&nbsp;M.A. Shamma ,&nbsp;M.A. Ali ,&nbsp;L.M. Milad","doi":"10.1016/j.ijoa.2025.104706","DOIUrl":"10.1016/j.ijoa.2025.104706","url":null,"abstract":"<div><h3>Background</h3><div>Spinal anesthesia is the preferred anesthetic for elective cesarean deliveries, though spinal hypotension requires prophylactic intervention to avoid serious complications. Several parameters have been studied to predict spinal hypotension; however, no reliable predictor has been identified to date. Spinal anesthesia induces femoral artery vasodilatation that induces flow velocity changes. Therefore, our study aimed to evaluate whether changes in femoral artery Doppler indices could serve as predictors of spinal hypotension.</div></div><div><h3>Methods</h3><div>This prospective observational study included pregnant women undergoing elective cesarean delivery. Spinal hypotension was defined as a reduction of systolic blood pressure of &gt;20 % of the baseline value. All patients received a co-load of lactated Ringer’s 200 mL over 10 minutes, and a prophylactic infusion of noradrenaline 0.08 µg/kg/min. An experienced operator performed Doppler examinations of the right common femoral artery before, immediately after, at two, and five minutes after spinal anesthesia. Pulsatility and resistive indices were calculated using built-in software. A receiver operating characteristic curve analysis was performed to assess the accuracy of Doppler indices in predicting spinal hypotension. The primary outcome variable was the accuracy of the change in pulsatility index in predicting spinal hypotension.</div></div><div><h3>Results</h3><div>Forty patients were included in the study. Patients with hypotension (n=13) showed higher baseline Pulsatility index, shock index, change in pulsatility index, change in resistive index, and change in waveform morphology. Doppler indices showed a good predictive ability for predicting spinal hypotension. The AUC (95% CI) for change in pulsatility index and resistive index to predict spinal hypotension were 0.99 (0.90–1.00) and 0.96 (0.85–1.00), respectively. In addition, the best cut-off values for the change in pulsatility and resistive indices to predict spinal hypotension were &gt;10.6% and 12%, respectively.</div></div><div><h3>Conclusion</h3><div>Our findings in women undergoing scheduled cesarean delivery under spinal anesthesia and prophylactic norepinephrine infusion show that changes in the femoral artery Doppler indices, specifically pulsatility index, resistive index, and waveform morphology, may predict spinal hypotension. Absent morphological changes after spinal anesthesia can rule out spinal hypotension, with a 100% negative predictive value.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104706"},"PeriodicalIF":2.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335931","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}

{"title":"A letter in response to “In Response to Discrimination, racism, and bias in childbirth pain management in the United States: a scoping review and directions for research and clinical care”","authors":"S.E. Harkins ,&nbsp;A.K. Hazi ,&nbsp;J. Guglielminotti ,&nbsp;R. Landau ,&nbsp;V. Barcelona","doi":"10.1016/j.ijoa.2025.104705","DOIUrl":"10.1016/j.ijoa.2025.104705","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104705"},"PeriodicalIF":2.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144331133","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}