International journal of obstetric anesthesia最新文献

{"title":"Anaesthesia practices for caesarean delivery in three clinical scenarios: the French CLATAC survey (2022–2023)","authors":"C. Garcia Cabrol ,&nbsp;J.C. Sleth ,&nbsp;J. Pissarra ,&nbsp;S. Bringuier ,&nbsp;F. Fuchs ,&nbsp;C. Dadure","doi":"10.1016/j.ijoa.2025.104785","DOIUrl":"10.1016/j.ijoa.2025.104785","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative pain during caesarean delivery (CD) remains a concern, particularly with epidural anaesthesia, with variable incidence depending on the circumstances. While spinal anaesthesia is the standard for scheduled CD, the best approach for unscheduled CD, especially with inadequate conversion of labour epidural analgesia to surgical epidural anaesthesia, remains unclear. We aimed to describe preferred anaesthetic practices among French anaesthesiologists in different clinical scenarios, with a particular focus on intrapartum CD with failed conversion of labour epidural analgesia.</div></div><div><h3>Methods</h3><div>A nation-wide, anonymous, online survey was distributed to anaesthesiologists. Participants were asked to indicate their preferred practices in clinical scenarios, including cases without labour epidural analgesia, with adequate labour epidural analgesia, and with inadequate conversion to surgical epidural anaesthesia, for three emergency levels.</div></div><div><h3>Results</h3><div>Between November 2022 and January 2023, 651 anaesthesiologists responded. Most respondents indicated preferring spinal anaesthesia for scheduled (97 %) and unscheduled non-urgent CD without LEA (95 %). In emergency situations, general anaesthesia (GA) was preferred (84 %). With adequate labour epidural analgesia, 99 % favoured epidural conversion. With inadequate labour epidural analgesia, 43 % indicated preferring spinal anaesthesia in non-urgent situations, while 70 % would opt for GA in emergency cases. Only 63 % of respondents were aware of risk factors for epidural conversion failure.</div></div><div><h3>Conclusions</h3><div>Anaesthetic practices were heterogeneous, particularly with inadequate labour epidural analgesia. These findings highlight the need for broader dissemination of updated guidelines and for standardized, evidence-based, clinical decision algorithms to support safe and effective anaesthetic management in complex clinical scenarios.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104785"},"PeriodicalIF":2.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212748","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":"Acute obstetric coagulopathy without severe postpartum haemorrhage following medical termination of pregnancy presenting as gingival bleeding: a case report","authors":"G. Thomas,&nbsp;A. Dhadda,&nbsp;Y. Metodiev","doi":"10.1016/j.ijoa.2025.104777","DOIUrl":"10.1016/j.ijoa.2025.104777","url":null,"abstract":"<div><div>Postpartum haemorrhage is a leading cause of maternal morbidity and mortality worldwide – rarely this is complicated by coagulopathy. Our understanding of the mechanisms of acute obstetric coagulopathy remains uncertain. This report aims to highlight the importance of its early recognition, diagnosis and management.</div><div>We report a case of acute obstetric coagulopathy potentially exacerbating postpartum haemorrhage following medical termination of pregnancy at 23 weeks gestation. We describe an unusual clinical presentation with gingival bleeding and evidence of hyperfibrinolysis beyond that of previously described cases. Despite the extreme coagulation abnormalities, the clinical situation did not proceed to severe postpartum haemorrhage owing to early suspicion and recognition of acute obstetric coagulopathy, as well as targeted treatment with fibrinogen concentrate and antifibrinolytics. The patient developed mild acute kidney injury which recovered spontaneously prior to discharge.</div><div>This case highlights the need for better understanding of acute obstetric coagulation and its underlying mechanisms. This specific coagulation disorder has been described relatively recently for the first time and has never been reported in patients undergoing a medical termination of pregnancy in the second trimester. Further research is needed to improve our understanding on its mechanisms and triggers to potentially inform optimal management.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104777"},"PeriodicalIF":2.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145134870","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":"Pulmonary complications following postpartum tubal ligation with laryngeal mask vs. endotracheal intubation: a retrospective cohort study (2012–2024)","authors":"A.F. Lindo ,&nbsp;D. Hincapié-Ayala ,&nbsp;S. Alzate-Ricaurte ,&nbsp;M. Rodríguez ,&nbsp;G.A. Cruz-Suárez ,&nbsp;M. Vasco-Ramírez","doi":"10.1016/j.ijoa.2025.104776","DOIUrl":"10.1016/j.ijoa.2025.104776","url":null,"abstract":"<div><h3>Background</h3><div>General anesthesia with endotracheal intubation is standard in obstetric patients due to the risk of aspiration. However, endotracheal intubation carries procedure-related risks, prompting interest in laryngeal masks as alternative or rescue devices. Evidence supporting their use in postpartum tubal ligation remains limited.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted at a high-risk obstetric center, including patients who underwent postpartum tubal ligation between 2012 and 2024. Patients were grouped according to the airway device used: laryngeal mask or endotracheal intubation, including those who required conversion. The primary outcome was the incidence of respiratory complications, including pneumonia, respiratory failure, anesthesia-related reactions, and other significant adverse events, within seven postoperative days. Secondary analyses included demographic and obstetric characteristics.</div></div><div><h3>Results</h3><div>There were 1,095 cases performed under general anesthesia, 503 (46 %) received endotracheal intubation and 592 (54 %) supra-glottic airway. No respiratory complications were observed in either group; Poisson-based confidence intervals confirmed that the upper bound of incidence remained &lt; 1 %. Patients with supra-glottic airway were more likely to be ASA I (34 % vs. 21 %), and 2.6 % had conversion to endotracheal intubation. Patients with endotracheal intubation had a higher median body mass index (29.7 vs. 29.2 kg/m², <em>P</em> = 0.027).</div></div><div><h3>Conclusion</h3><div>In this retrospective analysis of postpartum tubal ligation under general anesthesia, there were no respiratory complications with either airway device. Supraglottic airway devices appear to be a safe alternative in carefully selected patients.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104776"},"PeriodicalIF":2.3,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145134869","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":"Labor analgesia in pregnant women with reversible cerebral vasoconstriction syndrome managed with magnesium sulfate infusion to prevent exacerbation and recurrence: two case reports","authors":"T Nagase ,&nbsp;M. Shishii ,&nbsp;H. Kondo ,&nbsp;T. Fujita ,&nbsp;S. Hyuga","doi":"10.1016/j.ijoa.2025.104774","DOIUrl":"10.1016/j.ijoa.2025.104774","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104774"},"PeriodicalIF":2.3,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145134871","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":"Subdural hematoma following head trauma and spinal anesthesia for elective cesarean delivery: a case report","authors":"F. Boutamine","doi":"10.1016/j.ijoa.2025.104775","DOIUrl":"10.1016/j.ijoa.2025.104775","url":null,"abstract":"<div><div>Subdural hematoma is a rare but life-threatening complication of obstetric spinal anesthesia. We report a case of acute subdural hematoma following spinal anesthesia for elective cesarean delivery that likely promoted rebleeding from an unrecognized prepartum head trauma. A healthy 32-year-old primiparous patient (ASA II) underwent a cesarean delivery with spinal anesthesia performed with a 27-gauge Quincke needle. The perioperative course was uneventful; however thirty hours postoperatively, the patient developed a sudden severe fronto-orbital headache followed by progressive deterioration in consciousness and anisocoria. Emergency neuroimaging revealed an acute left temporal subdural hematoma with frontoparietal extension and mass effect. Further history-taking revealed a previously unreported minor head trauma one week prior to delivery. The patient underwent urgent surgical evacuation via craniectomy within one hour, resulting in rapid neurological improvement. By postoperative day three, the patient had made a full neurological recovery. This clinical presentation supports a two-hit mechanism: initial bridging-vein injury from minor trauma formed a pauci-symptomatic collection; spinal-induced cerebrospinal fluid hypotension then increased venous traction, precipitating rebleeding, amplifying mass effect.</div><div>This case underscores the importance of meticulous pre-anesthetic history-taking, particularly regarding recent head trauma, in obstetric patients scheduled for neuraxial anesthesia. The use of pencil-point small-gauge spinal needles is recommended to minimize the risk of dural puncture and subsequent cerebrospinal fluid leakage. Vigilance for atypical post-dural puncture headache, prompt neuroimaging, and urgent neurosurgical intervention were key to the favorable neurological outcome observed.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104775"},"PeriodicalIF":2.3,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206438","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 reponse to “This is how we do it, the Texas Children's protocol for fetoscopic myelomeningocele repairs”: anesthesia for the percutaneous fetoscopic biocellulose-based repair of open spina bifida","authors":"D. Lapa ,&nbsp;M. Benain ,&nbsp;B. Gatto","doi":"10.1016/j.ijoa.2025.104773","DOIUrl":"10.1016/j.ijoa.2025.104773","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104773"},"PeriodicalIF":2.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145117984","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":"Cesarean delivery with low-dose combined spinal epidural in a patient with congenital central hypoventilation syndrome: a case report","authors":"J.T. Le ,&nbsp;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}

{"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 ,&nbsp;Robert J. McCarthy ,&nbsp;Paloma Toledo ,&nbsp;Caroline L. Thomas ,&nbsp;Ian N. Gaston ,&nbsp;Alexander G. Samworth ,&nbsp;Pauline E. Ripchik ,&nbsp;Mikayla B. Troughton ,&nbsp;Carmen E. Lopez ,&nbsp;Jessica H. Kruse ,&nbsp;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}

{"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 ,&nbsp;M. Glynn ,&nbsp;R. Kearsley ,&nbsp;R. Drew ,&nbsp;M. Cotter ,&nbsp;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}

{"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 ,&nbsp;J. Hassan ,&nbsp;A. Karmakar ,&nbsp;M. Khan ,&nbsp;C.T. Dean ,&nbsp;B.M. Scavone ,&nbsp;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> &lt; 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> &lt; 0.01 and MD 5.39 mmHg; 95 % CI 2.17 to 8.60; <em>P</em> &lt; 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}