International journal of obstetric anesthesia最新文献

{"title":"Information about labor epidural analgesia: an updated evaluation on the readability, accuracy, and quality of ChatGPT responses incorporating patient preferences and complex clinical scenarios","authors":"C.W. Tan ,&nbsp;J.C.Y. Chan ,&nbsp;J.J.I. Chan ,&nbsp;S. Nagarajan ,&nbsp;B.L. Sng","doi":"10.1016/j.ijoa.2025.104688","DOIUrl":"10.1016/j.ijoa.2025.104688","url":null,"abstract":"<div><h3>Background</h3><div>Recent studies evaluating frequently asked questions (FAQs) on labor epidural analgesia (LEA) only used generic questions without incorporating detailed clinical information that reflects patient-specific inputs. We investigated the performance of ChatGPT in addressing these questions related to LEA with an emphasis on individual preferences and clinical conditions.</div></div><div><h3>Methods</h3><div>Twenty-nine questions for the AI chatbot were generated from the commonly asked questions relating to LEA based on clinical conditions. The generation of responses was performed in January 2025 with each question under individual sub-topics initiated as a “New chat” in ChatGPT-4o. Upon having the first questions answered, subsequent question(s) in the same sub-topic were continued in the same chat following the sequences as predefined. The readability of each response was graded using six readability indices, while the accuracy, Patient Education Materials Assessment Tool for Print (PEMAT) understandability and actionability was assessed by four obstetric anesthesiologists.</div></div><div><h3>Results</h3><div>The mean readability indices of the ChatGPT-4o responses to the questions were generally rated as fairly difficult to very difficult, which corresponded to a US grade level between 11th grade to college level entry. The mean (± standard deviation) accuracy of the responses was 97.7% ± 8.1%. The PEMAT understandability and actionability scores were 97.9% ± 0.9%) and 98.0% ± 1.4%), respectively.</div></div><div><h3>Conclusions</h3><div>ChatGPT can provide accurate and readable information about LEA even under different clinical contexts. However, improvement is needed to refine the responses with suitable prompts to simplify the outputs and improve readability. These approaches will thereby meet the need for the effective delivery of reliable patient education information.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104688"},"PeriodicalIF":2.6,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124689","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":"The effect of different information methods on patients’ anxiety and preference for spinal versus general anesthesia in a Turkish cohort of women scheduled for cesarean delivery: a prospective observational study","authors":"S.Ş. Karataş,&nbsp;O.K. Bulut,&nbsp;S.F. Öner","doi":"10.1016/j.ijoa.2025.104689","DOIUrl":"10.1016/j.ijoa.2025.104689","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative anxiety and misconceptions about spinal anesthesia often influence anesthesia preference in cesarean delivery. Patient education may improve both anxiety and informed decision-making.</div></div><div><h3>Methods</h3><div>In this prospective observational study, 300 pregnant women scheduled for elective cesarean delivery received one of three preoperative information methods: verbal explanation, pictorial illustration, or video-based education. Baseline and post- intervention anxiety were assessed using the State-Trait Anxiety Inventory (STAI) and Visual Analog Scale for Anxiety (VAS-A). Anesthesia preference and satisfaction were also recorded.</div></div><div><h3>Results</h3><div>Spinal anesthesia was initially preferred by 36% of participants. After receiving preoperative information, this rate increased to 73%. Among those who had initially preferred general anesthesia, 58.33% changed their choice. Preference change rates varied by information type: 43.33% following verbal information, 72.22% following graphic illustration information, and 56.67% with video-based information. Significant reductions were observed in both STAI and VAS-A scores across all groups (<em>P</em> &lt;0.005). High satisfaction was reported by most participants, including those who changed their preference.</div></div><div><h3>Conclusion</h3><div>Preoperative education significantly reduced anxiety and influenced anesthesia preference (changing from general to spinal anesthesia) for elective cesarean delivery. Graphic illustration were the most effective in promoting a change in preference in favor of spinal anesthesia. Integrating structured, visual educational tools into preoperative counseling may support informed maternal decision-making and improve perioperative experience.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104689"},"PeriodicalIF":2.6,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144135093","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":"Intrathecal catheter for labor analgesia and intrapartum cesarean delivery in a patient with Harrington rods: a case report","authors":"C.M. Quach,&nbsp;C.P. Duong,&nbsp;C.C. Paula Enverga Lua,&nbsp;P.R. Bertrand Macaire","doi":"10.1016/j.ijoa.2025.104687","DOIUrl":"10.1016/j.ijoa.2025.104687","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104687"},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130861","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":"Efficacy and safety of intravenous administration of dexamethasone on post-cesarean delivery pain: a systematic review and meta-analysis of current literature","authors":"Dimitrios Ioannopoulos ,&nbsp;Zoi Tsani ,&nbsp;Eleni Chatsiou ,&nbsp;Eleni Arnaoutoglou ,&nbsp;Georgia Tsaousi","doi":"10.1016/j.ijoa.2025.104682","DOIUrl":"10.1016/j.ijoa.2025.104682","url":null,"abstract":"<div><h3>Background</h3><div>Surgical tissue trauma induced by cesarean delivery serves as a pivotal stimulus for initiating the activation of nociceptors, leading to severe postoperative pain. Dexamethasone seems to mitigate pain-elicited inflammatory response and potentially serve as an analgesic adjunct in the post-cesarean period. This systematic review and meta-analysis aimed to assess the administration of intravenous dexamethasone for post-cesarean pain management.</div></div><div><h3>Methods</h3><div>An electronic database search involving PubMed, Scopus, CENTRAL, and the Public Library of Science was conducted to identify all randomized controlled trials (RCTs) pertinent to the analgesic efficacy of intravenous dexamethasone compared with placebo for cesarean delivery. The risk of bias and certainty of evidence in eligible trials were assessed using the ROB2 tool and the GRADE approach, respectively.</div></div><div><h3>Results</h3><div>Seventeen RCTs were included in the qualitative analysis, and 15 in the quantitative analysis. Intravenous dexamethasone was associated with prolonged time to first request for rescue analgesia (mean difference [MD] 3.33 hours, 95% CI 1.67 to 4.99; I² = 92.7%), lower opioid analgesic consumption (MD, −3.23 mg; 95% CI, −4.04 to −2.41; I² = 67.5%) within 24 hours and improved pain scores up to 24 hours postoperatively compared with placebo, however prediction intervals failed to confirm these favorable effects. The risk of postoperative nausea and vomiting was reduced with intravenous dexamethasone, but not that of pruritus.</div></div><div><h3>Conclusions</h3><div>Intravenous perioperative dexamethasone seems to be a promising adjunct to established analgesic modalities in cesarean delivery, with prolonged time to first request for rescue analgesia, reduced analgesic consumption, and reduced pain scores at rest up to 24 hours postoperatively. However, the substantial heterogeneity and low certainty of available evidence preclude any definite conclusions from being drawn.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104682"},"PeriodicalIF":2.6,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089516","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":"Failed epidural analgesia in a childhood cancer survivor who received intrathecal chemotherapy: a case report","authors":"J.A. Francke ,&nbsp;T.J. Guidugli ,&nbsp;B.W. Taha ,&nbsp;L.C. Tsen ,&nbsp;M.K. Farber ,&nbsp;A. Monroe ,&nbsp;A.R. Woytash","doi":"10.1016/j.ijoa.2025.104685","DOIUrl":"10.1016/j.ijoa.2025.104685","url":null,"abstract":"<div><div>The incidences of childhood leukemia and non-Hodgkin lymphoma (NHL) in the United States have steadily risen in the past two decades. Many patients with hematopoietic and lymphoid malignancies will receive both systemic and intrathecal chemotherapy to treat primary leptomeningeal cancer or secondary metastatic disease. Female survivors of childhood cancers may eventually desire parenthood, and the impact of intrathecal chemotherapy on neuraxial analgesia and anesthesia is unclear. We report a case of a primigravid parturient who, as a survivor of adolescent NHL, was treated with systemic and intrathecal methotrexate and cytarabine. Upon presenting for induction of labor in the setting of preeclampsia, the patient requested labor epidural analgesia. A dural puncture epidural (DPE) technique was performed by an experienced anesthesiologist, and though the procedure was straightforward, it resulted in minimal analgesic effect. Subsequently, a combined spinal epidural (CSE) analgesia was performed, with approximately two hours of analgesia followed by no epidural analgesia. An intentional dural puncture (17G) with an intrathecal catheter (20G) was discussed and accepted by the patient, and despite CSF confirmation, the technique was aborted due to significant catheter resistance. Our case of failed analgesia with multiple neuraxial techniques in a parturient who had previously received intrathecal chemotherapy raises a management dilemma. Future investigations into the impact of type, dose, duration, and cycles of intrathecal chemotherapy; the possible value of antepartum imaging; and the success of epidural or spinal analgesia and anesthesia are warranted.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104685"},"PeriodicalIF":2.6,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124690","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":"Maternal physiological parameters and routine laboratory tests to screen for maternal sepsis: an observational cohort study","authors":"T. Culling ,&nbsp;C. Bertorelli ,&nbsp;A. Strang ,&nbsp;S. Oram ,&nbsp;F. Faggian ,&nbsp;S. Sharma ,&nbsp;A. Ridgeway ,&nbsp;Summia Zaher ,&nbsp;Mario Labeta ,&nbsp;Simon A. Jones ,&nbsp;Luke C. Davies ,&nbsp;John Watkins ,&nbsp;Kate Siddall ,&nbsp;Vikki Keeping ,&nbsp;Kathryn Simpson ,&nbsp;Maryanne Bray ,&nbsp;Peter Ghazal ,&nbsp;Sarah F. Bell ,&nbsp;Rachel E. Collis","doi":"10.1016/j.ijoa.2025.104683","DOIUrl":"10.1016/j.ijoa.2025.104683","url":null,"abstract":"<div><h3>Background</h3><div>Maternal sepsis can lead to poor outcomes for the mother and neonate, and early diagnosis and treatment of infection is important to prevent sepsis. Current guidance to recognise maternal sepsis includes assessment of physiological markers, however normal physiological changes of pregnancy can hinder the diagnosis of sepsis. This study investigated the utility of routine clinical variables, including laboratory tests, in screening for maternal sepsis.</div></div><div><h3>Methods</h3><div>Patients considered at risk of obstetric sepsis were recruited into a single centre cohort study. Microbiological, histological and clinical data categorised patients into three diagnostic groups: ‘infection confirmed’, ‘infection unknown’ and ‘infection unlikely’. Differences in physiological and routine laboratory variables were investigated.</div></div><div><h3>Results</h3><div>Between November 2020 and December 2022, 154 pregnant patients were recruited. Comparison between ‘infection confirmed’ (n=58) and ‘infection unlikely’ (n=17) showed statistical differences in temperature (<em>P</em> &lt;0.001), neutrophil count (<em>P</em> =0.003) and leukocyte count (<em>P</em> =0.004) at the time of recruitment. Temperature was the best discriminator with an area under the receiver operating characteristic curve (AUC-ROC) of 0.82 (95% CI 0.70 to 0.94, <em>P</em> &lt;0.0001) with an optimal threshold of ≥37.5°C.</div></div><div><h3>Conclusion</h3><div>This observational cohort study demonstrated that maternal temperature ≥37.5°C (rather than the threshold of 38°C found in most screening tools) may be important in screening patients at risk of developing maternal sepsis. When temperature ≥37.5°C persists, medical care should be expedited and maternal infection considered.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104683"},"PeriodicalIF":2.6,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144147272","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":"Intraoperative fentanyl versus paracetamol for ultrasound-guided oocyte retrieval analgesia: a randomised clinical trial","authors":"E. Farladansky ,&nbsp;B. Cohen ,&nbsp;B. Almog ,&nbsp;C. Weiniger ,&nbsp;S. Hazan ,&nbsp;L. Barzilay ,&nbsp;S. Haim","doi":"10.1016/j.ijoa.2025.104681","DOIUrl":"10.1016/j.ijoa.2025.104681","url":null,"abstract":"<div><h3>Background</h3><div>Despite its brief duration, transvaginal ultrasound-guided oocyte retrieval is a potentially painful procedure often managed with opioid-based sedation. This study evaluated whether intravenous paracetamol could provide postoperative analgesia comparable to fentanyl.</div></div><div><h3>Methods</h3><div>We investigated two multimodal anaesthesia regimens, one including intravenous (IV) paracetamol and the other IV fentanyl, for postoperative analgesia in a single-center, single-blinded, randomised, non-inferiority trial. Healthy women with ≤15 follicles identified by ultrasound undergoing oocyte retrieval under general anaesthesia (propofol) were randomised to receive IV paracetamol 1000 mg vs IV fentanyl 100 μg. The primary outcome was median postoperative pain on an 11-point numerical rating scale (NRS) scores (0 = no pain, 10 = worst imaginable pain) at five predefined time points within the first two postoperative hours. Secondary outcome measures included sedation scale (Pasero), Aldrete scale, discharge time, patient satisfaction with anaesthesia (5-point Likert scale), administration of supplemental analgesia and antiemetics.</div></div><div><h3>Results</h3><div>In total, 100 patients were enrolled with 95 cases analysed. Median [IQR] NRS scores were 0 [0–1] in the paracetamol group and 0 [0–1] in the fentanyl group (<em>P</em> =0.31), indicating non-inferiority. There were no differences between groups in the rate of low Pasero score (84% with paracetamol vs 87% with fentanyl, <em>P</em> =0.98), Aldrete scores, use of postoperative analgesia, prolonged discharge time (&gt;60 minutes) or satisfaction scores (median 5 in both groups, <em>P</em> =0.90).</div></div><div><h3>Conclusion</h3><div>Intra-operative IV paracetamol 1000 mg was non-inferior to fentanyl 100 μg for post-procedure analgesia, suggesting opioid-free anaesthesia may be an acceptable approach for ≤15 follicles ultrasound-guided oocyte retrievals.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104681"},"PeriodicalIF":2.6,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184949","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":"Head elevating device and cricothyroid membrane position in pregnant women with obesity class 3: an observational study","authors":"F. Zasso ,&nbsp;A. Spring ,&nbsp;J.F. Casellato ,&nbsp;E. Wild ,&nbsp;E. You-Ten ,&nbsp;J.C.A. Carvalho ,&nbsp;J. Morales ,&nbsp;K. Downey ,&nbsp;X.Y. Ye ,&nbsp;N. Siddiqui","doi":"10.1016/j.ijoa.2025.104680","DOIUrl":"10.1016/j.ijoa.2025.104680","url":null,"abstract":"<div><h3>Background</h3><div> <!-->Obesity and pregnancy are risk factors for difficult intubation. A head-elevating positioning device increases functional residual capacity and improves direct laryngoscopy. It is unclear what effect such device has on the airway anatomy. The primary aim of this study was to determine the change in distance from the sternal notch to the cricothyroid membrane (CTM) mid-point among pregnant women with class 3 obesity, comparing the supine positioning and the head-elevated position.</div></div><div><h3>Methods</h3><div> <!-->In this prospective observational study, 50 pregnant women with class 3 obesity provided their consent for participation, and airway anatomy was assessed with ultrasound when presenting either for elective cesarean delivery or in early stages of labor. The CTM’s depth and height were measured in supine (Time 1) and head-elevated (Time 2) positions. The CTM midpoint was established and the distance from this point to the sternal notch was obtained. The primary outcome was change in distance from sternal notch to CTM midpoint. Secondary outcomes included changes in CTM depth and height.</div></div><div><h3>Results</h3><div>The median (± standard deviation) sternal notch to CTM midpoint distance increased significantly from 41.07 mm (± 8.35 at Time 1 to 45.40 mm ± 8.97) at Time 2 (mean difference 4.33 mm, 95% CI 3.06 to 5.61, <em>P</em> &lt;0.0001). No differences were observed in CTM depth (mean difference −0.15 mm, <em>P</em> =0.66) or height (mean difference 0.34 mm, <em>P</em> =0.20).</div></div><div><h3>Conclusion</h3><div> <!-->Head elevation increased the distance from the sternal notch to the CTM midpoint but did not affect CTM depth or height in pregnant women with class 3 obesity. Further research is needed to assess neck ultrasound anatomy in high-risk patients for difficult intubation.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104680"},"PeriodicalIF":2.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144185008","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":"O.010 Pre-operative carbohydrate drink loading versus ‘Sip til send’: A randomised controlled trial of two fasting protocols at elective caesarean delivery","authors":"Shoaib Sadiq,&nbsp;Caitriona Murphy,&nbsp;Thomas Drew","doi":"10.1016/j.ijoa.2025.104389","DOIUrl":"10.1016/j.ijoa.2025.104389","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104389"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143934638","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":"P.028 How are sites across the UK escalating care during a postpartum haemorrhage?","authors":"Amrit Dhadda,&nbsp;Alexander Johnson,&nbsp;Sarah Bell","doi":"10.1016/j.ijoa.2025.104407","DOIUrl":"10.1016/j.ijoa.2025.104407","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"62 ","pages":"Article 104407"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143935053","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}