International journal of obstetric anesthesia最新文献

{"title":"A matter of justice: an obstetric anesthesia workforce survey of the United States highlights the unequal access to anesthesia care for childbirth","authors":"R.B. George ,&nbsp;M.I. Zakowski","doi":"10.1016/j.ijoa.2025.104699","DOIUrl":"10.1016/j.ijoa.2025.104699","url":null,"abstract":"<div><div>Disparities in anesthesia services for labor and delivery constitute a persistent, structural inequity in healthcare, affecting peripartum outcomes, and perpetuating needless suffering. Labor and delivery units should be resourced equivalently to surgical suites. Institutions, funding organizations, and quality assurance programs should include anesthesia readiness as a marker of maternal safety. Improving access will require a coordinated response starting with redesigning staffing models to reflect demand variability and acuity. We must confront these systemic inequities that limit access to anesthesia care because access to safe, timely anesthesia in childbirth is not a privilege, it is a right.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104699"},"PeriodicalIF":2.6,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270316","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]¿Es eficaz el ácido tranexámico profiláctico para prevenir la hemorragia posparto? Casi con toda seguridad, no","authors":"Anne-Sophie Bouthors,&nbsp;Maxence Hureau,&nbsp;Alexander Butwick","doi":"10.1016/j.ijoa.2025.104698","DOIUrl":"10.1016/j.ijoa.2025.104698","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104698"},"PeriodicalIF":2.6,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270315","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":"Mothers’ experiences of category 1 caesarean delivery under general anaesthesia with the partner present: a prospective explorative study","authors":"H.K. Nedergaard ,&nbsp;E.E. Weitling ,&nbsp;H.I. Jensen ,&nbsp;A.C. Brøchner","doi":"10.1016/j.ijoa.2025.104693","DOIUrl":"10.1016/j.ijoa.2025.104693","url":null,"abstract":"<div><h3>Background</h3><div>A category 1 caesarean delivery (CD) is performed when there is an immediate threat to the life of mother and/or infant, with an expected decision-to-delivery interval benchmarked to be maximum 15 minutes in Denmark. Often category 1 CD are performed under general anaesthesia to save time. The partner traditionally waits outside the operating room, but since 2021 partners in our center follow the mother into the operating room and stay throughout the entire procedure. We previously found that partners much preferred accompanying the mother to waiting outside. The aim of this study was to investigate how mothers experience category 1 CD with their partner present.</div></div><div><h3>Methods</h3><div>Qualitative single-center study, involving mothers having category 1 CD over a period of 18 months. Semi-structured telephone interviews were conducted three months after the CD, including a screening for posttraumatic stress. Interviews were transcribed verbatim and analysed with manifest content analysis.</div></div><div><h3>Results</h3><div>In total, 22 category 1 CD occurred. All mothers agreed to participate. All infants survived. The identified themes regarding the mothers’ experiences were: sorrow over having missed out on vaginal birth and on the first moments with the child; feeling in good hands; partners’ presence provided support, both in the emergency situation and during the psychological recovery process afterwards. No mothers had post-traumatic stress.</div></div><div><h3>Conclusions</h3><div>The mothers felt sorrow over having missed out, however the partners’ presence provided comfort and was helpful afterwards. Staff acting calm and professional helped the mothers cope in the emergency situation. No mothers developed post-traumatic stress.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104693"},"PeriodicalIF":2.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223568","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":"Current strategies for the diagnosis and management of postpartum hemorrhage: a focused review of four Cochrane Systematic Reviews from 2024 and 2025","authors":"Y. Binyamin ,&nbsp;S. Orbach-Zinger ,&nbsp;M. Heesen","doi":"10.1016/j.ijoa.2025.104692","DOIUrl":"10.1016/j.ijoa.2025.104692","url":null,"abstract":"<div><div>Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality worldwide, particularly in low-resource settings. Despite international initiatives, significant variability persists in how PPH is diagnosed and managed. This integrative review synthesizes findings from four recent Cochrane systematic reviews published in 2024 and 2025, aiming to inform clinical practice and highlight research gaps. The included reviews examined: (1) diagnostic accuracy of tools during vaginal birth, (2) implementation strategies for WHO guidelines, (3) transfusion of blood and blood products, and (4) intraoperative cell salvage during cesarean delivery.</div><div>Calibrated blood loss tools combined with clinical observation demonstrated superior performance compared to visual estimation, with pooled sensitivity of 93% and specificity of 95%. Multicomponent strategies modestly improved adherence to WHO-recommended practices, yet had limited impact on maternal mortality and ICU admissions. Evidence regarding transfusion thresholds, fibrinogen concentrate, and cryoprecipitate was of low certainty and inconclusive. Intraoperative cell salvage showed potential benefits, including a reduction in total blood loss (mean difference –113.6 mL) and a modest increase in postpartum hemoglobin (mean difference +6.14 g/L), although the overall quality of evidence remains low.</div><div>This review underscores the value of objective measurement tools and structured implementation efforts in improving PPH care. However, transfusion and salvage practices require further validation in high-quality randomized trials. Greater attention is needed to address context-specific challenges, particularly in settings with limited resources.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104692"},"PeriodicalIF":2.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223507","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 anesthesia in Japan: an existential crisis in need of an intervention","authors":"A. Maeda ,&nbsp;Y. Mazda ,&nbsp;R. Ohara ,&nbsp;S. Tanabe ,&nbsp;M. Tokiwa ,&nbsp;W. Camann","doi":"10.1016/j.ijoa.2025.104690","DOIUrl":"10.1016/j.ijoa.2025.104690","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104690"},"PeriodicalIF":2.6,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262564","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 importance of inclusion of neonatal outcomes in analysis of maternal peri-operative intravenous dexamethasone – reply to “Efficacy and safety of intravenous administration of dexamethasone on post-cesarean delivery pain: A systematic review and meta-analysis of current literature.”","authors":"A. Impiumi,&nbsp;R. Kearsley","doi":"10.1016/j.ijoa.2025.104691","DOIUrl":"10.1016/j.ijoa.2025.104691","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104691"},"PeriodicalIF":2.6,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144331132","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":"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}