International journal of obstetric anesthesia最新文献

{"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}

{"title":"Effect of prophylactic intravenous calcium gluconate on uterine atony during intrapartum cesarean delivery with spinal anesthesia: a placebo controlled, randomized clinical trial","authors":"T.L. Abirami ,&nbsp;P. Rudingwa ,&nbsp;A.K. Jha ,&nbsp;A. Kuberan ,&nbsp;N.S. Kubera ,&nbsp;S. Ramachandran ,&nbsp;B. Ravichandrane","doi":"10.1016/j.ijoa.2025.104704","DOIUrl":"10.1016/j.ijoa.2025.104704","url":null,"abstract":"<div><h3>Background</h3><div>Nearly two-thirds of postpartum hemorrhage is due to uterine atony. Calcium ions play a vital role in myometrial contraction and may improve uterine tone. However, studies utilizing calcium to prevent uterine atony are limited, and have yielded conflicting findings. We designed this study to evaluate the effect of prophylactic intravenous calcium on uterine tone during intrapartum cesarean delivery with spinal anesthesia.</div></div><div><h3>Method</h3><div>This prospective, randomized, placebo-controlled, two-arm blinded trial was performed in patients undergoing intrapartum cesarean delivery with spinal anesthesia. Patients were randomized to receive intravenous calcium gluconate 1 g (93 mg elemental calcium) or placebo (normal saline) over 10 minutes after umbilical cord clamping. The primary outcome measure was uterine tone, assessed five times by the obstetrician using an 11-point verbal numeric rating score (0 = completely atonic; 10 = fully contracted). Secondary outcomes were postpartum blood loss, additional uterotonic administration, and blood product transfusion.</div></div><div><h3>Result</h3><div>Three hundred sixty-seven patients (183 in the calcium group and 184 in the placebo group) participated in the trial. Demographic variables were comparable. The uterine tone score (mean ± standard deviation) increased from baseline by 2.67 ± 0.97 in the calcium group and by 2.79 ± 0.98 in the placebo group, respectively (<em>P</em> =0.11). The uterine tone score (median with range) 10 minutes after the end of study drug infusion was 8 (6–10) in the calcium group vs. 8 (4–10) in the placebo group (<em>P</em> =0.002) However, the postpartum blood loss was significantly lower in the calcium group (526.0 ± 155.2 vs. 581.5 ± 148.9 mL; mean difference of 55.6 mL; 95% CI 24.3 to 86.8, <em>P</em> =0.001). Additional uterotonic administration was lower in the calcium group (21.7% vs. 42.39%; RR was 0.51; 95% CI 0.37 to 0.71, <em>P</em> =0.001). Nonetheless, transfusion and vasopressor requirements were comparable.</div></div><div><h3>Conclusion</h3><div>Intravenous calcium gluconate (1 g) did not improve uterine tone, evaluated by the obstetricians with a numeric rating score, during intrapartum cesarean delivery with spinal anesthesia, though it significantly reduced additional uterotonics administration.</div><div>The trial was registered at the clinical trial registry of India (CTRI/2022/12/047912) on 06/12/2022.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104704"},"PeriodicalIF":2.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144240861","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 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":"A.T. Gilman ,&nbsp;M.H. Andreae ,&nbsp;R.S. White","doi":"10.1016/j.ijoa.2025.104701","DOIUrl":"10.1016/j.ijoa.2025.104701","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104701"},"PeriodicalIF":2.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144253810","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 SuPPORT project: Supporting Parents and Professionals through NeOnatal resuscitation in theatre. Phases 1 and 2: qualitative synthesis and capture of current practice","authors":"E. Godfrey ,&nbsp;T. Kitchen ,&nbsp;N. Harris ,&nbsp;S. Channon","doi":"10.1016/j.ijoa.2025.104702","DOIUrl":"10.1016/j.ijoa.2025.104702","url":null,"abstract":"<div><h3>Background</h3><div>The anaesthetic team routinely act as the initial information providers to mothers and birth partners during neonatal resuscitation in obstetric theatre. This situation presents unique, under-researched communication challenges. Through exploration of parental and professional voices, we aimed to describe the determinates of high-quality communication during this time.</div></div><div><h3>Methods</h3><div>This was a two-phase, mixed-method study. In phase 1, a scoping exercise involved parents with personal experience of neonatal resuscitation in theatre; In phase 2, an anaesthetic staff questionnaire explored professional experiences and communication during neonatal resuscitation in theatre across all Welsh National Health Service (NHS) hospitals with secondary obstetric services.</div></div><div><h3>Results</h3><div>The qualitative framework analysis revealed overlapping themes from 112 parent responses (phase 1) and 175 anaesthetic staff responses (phase 2). In phase 1, parents reported positive experiences reflecting their desire for clear, honest, timely information delivered compassionately, alongside the use of photos and videos. Challenging experiences highlighted a perceived lack of information, insensitive, impersonal communication and processes, the use of jargon and a challenging environment. In phase 2, the staff demonstrated high exposure to, and negative emotional impact from neonatal resuscitation experiences. Communication barriers included restricted situational insight, emotional stress alongside complex care delivery. Strategies to assist communication included actively seeking information, providing a compassionate approach, offering assurances and managing the environment. Training in communication during neonatal resuscitation was reported by 4% (7/175) of staff.</div></div><div><h3>Conclusion</h3><div>In this mixed-model qualitative study, we identified that mothers and birth partners desired clear, honest updates delivered with compassion. Assurances of high-quality care provision for their baby alongside avoidance of false reassurance were important. Anaesthetic staff recognised their role in providing this information but reported lacking confidence to do so and would welcome training. The reported results can be used to inform the development of evidenced-based tools and training.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104702"},"PeriodicalIF":2.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366326","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 role of human factors in the decision to administer general anaesthesia for emergency caesarean deliveries: a qualitative interview study of anaesthesia trainees in Ireland","authors":"S. Hannon ,&nbsp;O. Elabassy ,&nbsp;R. Free ,&nbsp;A. Afridi ,&nbsp;R. Ffrench-O’Carroll","doi":"10.1016/j.ijoa.2025.104696","DOIUrl":"10.1016/j.ijoa.2025.104696","url":null,"abstract":"<div><h3>Background</h3><div>Neuraxial anaesthesia is generally preferred over general anaesthesia (GA) for emergency caesarean deliveries (CD) due to its benefits for both mother and baby. While GA is sometimes required and unavoidable, it may also be performed unnecessarily in some cases. This study aimed to explore how trainee anaesthetists make the decision to administer GA for emergency caesarean delivery and more specifically how human factors may influence this decision-making process.</div></div><div><h3>Methods</h3><div>Following ethical approval, we conducted 12 semi-structured interviews with trainee anaesthetists, who recounted recent cases where GA was administered for emergency CD. The Critical Decision Method and Human Factors Interview Protocol were used to analyse key decision-making influences. Content analysis was performed independently by two investigators.</div></div><div><h3>Results</h3><div>Results showed that decision to administer GA was significantly influenced by fetal wellbeing, the patient’s perspective, time constraints, communication approaches, as well as prior experience and the organisational structure. Barriers to effective decision-making included poor communication and team dynamics, time pressure, limited experience in similar cases and organisational structure. Conversely, enablers of effective decision-making included senior staff presence and continuous interdisciplinary communication.</div></div><div><h3>Conclusion</h3><div>These findings highlight the significant role of human factors in the decision to administer GA for emergency CD. Key areas for improvement identified in our institution include interdisciplinary communication and the language used to convey urgency, which may enhance decision-making and reduce unnecessary GA use.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104696"},"PeriodicalIF":2.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144331131","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":"Artificial intelligence in prediction of postpartum hemorrhage: a primer and review","authors":"B.M. Wakefield ,&nbsp;M.A. Zapf ,&nbsp;H.B. Ende","doi":"10.1016/j.ijoa.2025.104694","DOIUrl":"10.1016/j.ijoa.2025.104694","url":null,"abstract":"<div><div>Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide, and the ability to predict PPH may help address preventable causes of morbidity and mortality such as delays in care. Understanding the importance of standardized approaches to PPH, the National Partnership for Maternal Safety Consensus Bundle on Obstetric Hemorrhage outlines four critical domains for safe and effective PPH care: 1) Readiness; 2) Recognition and Prevention; 3) Response; and 4) Reporting and System Learning. The Recognition and Prevention domain includes recommendations for standardized methods of PPH risk prediction, and The Joint Commission now requires use of an evidence-based PPH prediction tool. Postpartum hemorrhage risk predictions can be accomplished via checklist tools completed manually by healthcare providers or via machine-assisted calculations in the form of logistic regression or machine learning populated by automated electronic health record data. The latter examples of machine-assisted calculations of PPH risk are a form of artificial intelligence.</div><div>The purpose of this review is to describe the current state of AI-based PPH risk assessment, including the application of logistic regression and machine learning. A primer on interpretation of such models is provided, along with identification of research gaps and future directions.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104694"},"PeriodicalIF":2.6,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298584","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":"Neurological complications following obstetric neuraxial anaesthesia: a four-year United Kingdom population-based study of epidural haematoma and epidural abscess (2014–2017)","authors":"R. Tunn ,&nbsp;R. Ramakrishnan ,&nbsp;R. Hartopp ,&nbsp;M. Knight ,&nbsp;D.N. Lucas ,&nbsp;F. Plaat","doi":"10.1016/j.ijoa.2025.104700","DOIUrl":"10.1016/j.ijoa.2025.104700","url":null,"abstract":"<div><h3>Background</h3><div>Epidural haematoma and epidural abscess are rare but serious complications of obstetric neuraxial anaesthesia. We investigated their incidence, diagnosis, management, and outcomes in the UK.</div></div><div><h3>Methods</h3><div>This prospective, population-based study used the UK Obstetric Surveillance System to collect data on all cases of epidural haematoma or abscess occurring in obstetrician-led UK maternity units between January 2014 and December 2017.</div></div><div><h3>Results</h3><div>Six cases of epidural haematoma and 11 of epidural abscess were confirmed, giving estimated incidences of 1.97 (95% CI 0.72 to 4.29) and 3.61 (95% CI 1.80 to 6.46) per 1,000,000 maternities, respectively. Women with haematoma commonly reported pain or tenderness (3/6) and fever (2/6). All women with abscess presented with pain; eight had tenderness, six fever, and four lower limb motor block. Diagnosis was confirmed by MRI in all cases. Risk factors for haematoma included perinatal anticoagulant therapy (1/6) and multiple catheter attempts in one woman. Among women with abscess, aseptic precautions were potentially suboptimal in around 70% of cases. No immunodeficiency was reported. Two women with haematoma and six with abscess underwent surgery, with antibiotics used in one and four of these cases, respectively. Three women with abscess received antibiotics alone. Expectant management was used in two-thirds of haematoma cases and one abscess case. There were no maternal deaths, ICU admissions, stillbirths, or neonatal deaths, though three women experienced major maternal morbidity.</div></div><div><h3>Conclusions</h3><div>Epidural abscess and haematoma were rare complications of obstetric neuraxial anaesthesia in the UK, with most women recovering well, though a minority experienced major morbidity.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104700"},"PeriodicalIF":2.6,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262565","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":"Anesthetic and perioperative management of pregnant patients undergoing neurosurgery: a case series from a single center in Morocco (2017–2024)","authors":"I. Daoudi,&nbsp;D. Doughmi,&nbsp;S. Benlamkaddem,&nbsp;A. Berdai,&nbsp;M. Harandou","doi":"10.1016/j.ijoa.2025.104695","DOIUrl":"10.1016/j.ijoa.2025.104695","url":null,"abstract":"<div><h3>Background</h3><div>Maternal mortality remains a critical global health challenge, with neurological causes, including traumatic brain injuries, intracranial hemorrhages, and neoplasms, emerging as significant contributors. Optimizing anesthesia care for neurosurgical interventions in pregnant patients is particularly complex due to limited literature and lack of standardized guidelines. This study aimed to evaluate and report on the anesthetic management and maternal and fetal outcomes in such patients in a resource-limited setting.</div></div><div><h3>Methods</h3><div>This retrospective case series included pregnant patients who underwent neurosurgery between January 2017 and December 2024 at Hassan II University Hospital in Fez, Morocco. Cases were identified through electronic hospital records, operating room logs, and intensive care unit registry. Demographic, obstetric, neurosurgical, anesthetic, and outcomes data were extracted from medical records. Outcomes were assessed using the Glasgow Coma Scale, Glasgow Outcome Scale–Extended, and Apgar score at 5 minutes.</div></div><div><h3>Results</h3><div>Ten patients were identified and included. Mean maternal age was 26.4 ± 6.2 years, and median gestational age at surgery was 25 weeks + 4 days [10–34]. Diagnoses included traumatic brain injury (n=4), spontaneous intracerebral hemorrhage (n=3), neuro-meningeal tuberculosis (n=1), severe cerebral infarction (n=1), and venous sinus thrombosis (n=1). Anesthesia involved total intravenous anesthesia (n=4) or propofol–sevoflurane combinations (n=6). Osmotic therapy was used in seven cases. Four patients died following cerebral complications. Two intrauterine fetal demises occurred. All cesarean deliveries were performed under general anesthesia without perioperative complications.</div></div><div><h3>Conclusions</h3><div>Maternal outcomes were primarily influenced by the severity and etiology of the neurological pathology. General neuro-anesthesia protocols, including propofol-based total intravenous anesthesia and intracranial pressure −guided hemodynamic management, were utilized. These findings highlight the need for multidisciplinary protocols and context-adapted guidelines.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104695"},"PeriodicalIF":2.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307040","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":"[Artículo traducido] Más allá de la punción: nuevas pautas para el manejo del catéter intratecal en anestesia obstétrica","authors":"Yair Binyamin,&nbsp;Sharon Orbach-Zinger,&nbsp;Michael Heesen","doi":"10.1016/j.ijoa.2025.104697","DOIUrl":"10.1016/j.ijoa.2025.104697","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104697"},"PeriodicalIF":2.6,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270314","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}