International journal of obstetric anesthesia最新文献

{"title":"Development of a contraction-based pain index (CONPAIN) to evaluate labor epidural analgesia effectiveness: a pilot proof-of-concept study","authors":"A. Calabrese ,&nbsp;P.L. Dragoni ,&nbsp;C.T. Montserrat ,&nbsp;M. Gheghici ,&nbsp;I. Borelli ,&nbsp;M. Taddei ,&nbsp;C. Compagnone ,&nbsp;E.G. Bignami","doi":"10.1016/j.ijoa.2025.104759","DOIUrl":"10.1016/j.ijoa.2025.104759","url":null,"abstract":"<div><h3>Background</h3><div>Assessment of labour pain is essential to guide neuraxial analgesia, yet current tools such as the Numeric Rating Scale (NRS) are influenced by subjective variability. We developed and tested the Contraction Pain Index (CONPAIN), calculated as the percentage ratio of self-reported pain duration to contraction duration measured on external cardiotocography. We hypothesised that CONPAIN would show an early relative change from baseline than NRS in the first 10 minutes after dosing.</div></div><div><h3>Methods</h3><div>In this exploratory, single-center pilot study, CONPAIN and NRS were recorded in 27 nulliparous women in active labor before and after initiation of epidural analgesia. Data collection started five minutes before the initial epidural bolus and continued for 20 min thereafter. The primary outcome was the temporal trend of CONPAIN relative to baseline; secondary outcome was the comparison of percentage change from baseline between CONPAIN and NRS and their correlation over time.</div></div><div><h3>Results</h3><div>Both metrics decreased within the first five minutes. Median percentage change at 0–5 minutes was −27.96 % for CONPAIN vs. −7.14 % for NRS (<em>P</em> &lt; 0.001); at 6–10 minutes, −48.99 % vs. −40.00 % (<em>P</em> = 0.027). Differences were not significant after 10 minutes.</div></div><div><h3>Conclusions</h3><div>In this proof-of-concept study, CONPAIN showed greater relative changes compared to NRS during the first 10 minutes following initiation of labour analgesia, suggesting potential value in characterising the early dynamics of analgesic response. While these findings offer preliminary support for its clinical relevance, validation in larger populations is required.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104759"},"PeriodicalIF":2.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144911975","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":"Rethinking anesthetic management of patients with indwelling labor epidural catheters who have unscheduled intrapartum cesarean deliveries: a response to “The Retrievals, Season 2”","authors":"M.P. Hofkamp ,&nbsp;E.E. Sharpe","doi":"10.1016/j.ijoa.2025.104757","DOIUrl":"10.1016/j.ijoa.2025.104757","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104757"},"PeriodicalIF":2.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885724","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":"Rethinking equipotent vasopressor dosing in spinal hypotension management. In response to “Relative potency of norepinephrine and mephentermine bolus for the treatment of spinal hypotension during elective caesarean delivery: a randomized, blinded up-down sequential allocation study”","authors":"H. Shekhar,&nbsp;P. Aphale,&nbsp;S. Dokania","doi":"10.1016/j.ijoa.2025.104756","DOIUrl":"10.1016/j.ijoa.2025.104756","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104756"},"PeriodicalIF":2.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885723","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 metoclopramide on gastric volume and nausea and vomiting in fasted patients undergoing elective cesarean delivery: a randomized clinical equivalence trial","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.2025.104754","DOIUrl":"10.1016/j.ijoa.2025.104754","url":null,"abstract":"<div><h3>Background</h3><div>The American Society of Anesthesiologists Practice Guidelines for Obstetric Anesthesia recommend preoperative fasting and aspiration prophylaxis including non-particulate antacids, H₂-receptor antagonists, and/or metoclopramide for elective cesarean deliveries. This study evaluated the effect of metoclopramide on gastric volume in appropriately fasted patients undergoing elective cesarean delivery.</div></div><div><h3>Methods</h3><div>We conducted a single-center, randomized, placebo-controlled equivalence trial of appropriately fasted patients presenting for elective cesarean delivery. Patients were randomized to receive intravenous metoclopramide 10 mg or saline. Gastric ultrasound was performed before and 30 minutes after study medication administration in the right lateral decubitus and the supine positions. Gastric volumes were estimated using the Roukhomovsky and Perlas methods. We hypothesized that metoclopramide would not significantly decrease gastric volume compared to saline within the equivalence limits of ± 17 mL.</div></div><div><h3>Results</h3><div>Seventy-two patients completed the study. Median gastric volume estimates were greater using the Roukhomovsky compared to the Perlas method (pre-treatment difference 13 mL, <em>P</em> &lt; 0.001; post-treatment difference 11 mL, <em>P</em> &lt; 0.001). No differences in the number of patients identified as at risk for aspiration (gastric volume &gt; 1.5 mL/kg) were found between groups. The median pre- to post-treatment difference in gastric volume between saline and metoclopramide groups, calculated using the Perlas method, was −1 mL (95 % CI −5 to 2, <em>P</em> = 0.375) and 1 mL (95 % CI −4 to 5, <em>P</em> = 0.981) using the Roukhomovsky method. Equivalence was determined significant for both methods (<em>P</em> &lt; 0.001).</div></div><div><h3>Discussion</h3><div>In appropriately fasted patients, metoclopramide and saline were equivalent in their effect on gastric volume within ± 17 mL, showing metoclopramide administration had minimal effect on gastric volume in this low-risk population.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104754"},"PeriodicalIF":2.3,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908979","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":"Serotonin syndrome following spinal anaesthesia for elective caesarean delivery: a case report","authors":"L. Uthayanan,&nbsp;T. Kannan","doi":"10.1016/j.ijoa.2025.104755","DOIUrl":"10.1016/j.ijoa.2025.104755","url":null,"abstract":"<div><div>Serotonin syndrome during the perioperative period is difficult to recognise, and its diagnosis can be challenging due to the variety of clinical features that may mimic more familiar conditions known to anaesthetists. Most cases of serotonin syndrome in the perioperative setting have been reported in the postoperative period, with none occurring during a caesarean delivery. We describe an unusual case of intraoperative serotonin syndrome that developed immediately following spinal anaesthesia in a patient undergoing an elective caesarean delivery. The patient, who was taking sertraline at the time of anaesthesia, developed pyrexia, diaphoresis, spontaneous rigidity, episodes of arrhythmias, became unresponsive and went into peri-arrest. We postulate plausible mechanisms, including the role of opioids, intrathecal bupivacaine, and acute stress that may have contributed to the onset of serotonin syndrome. The case underscores the importance of early identification of serotonin syndrome and its presentation in obstetric patients.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104755"},"PeriodicalIF":2.3,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904517","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":"Characterizing patterns of sensory loss during labor epidural analgesia: a prospective study of breakthrough pain","authors":"L Kordich ,&nbsp;JP Ghiringhelli ,&nbsp;RB George ,&nbsp;K Downey ,&nbsp;XY Ye ,&nbsp;JCA Carvalho","doi":"10.1016/j.ijoa.2025.104753","DOIUrl":"10.1016/j.ijoa.2025.104753","url":null,"abstract":"<div><h3>Background</h3><div>Two distinct levels of sensory loss can be detected while assessing the cephalad spread of epidural analgesia during labor: the level of complete sensory loss (cephalad dermatome with complete sensory loss to a testing stimulus) and the level of partial sensory loss (cephalad dermatome of partial sensation to the same stimulus). This study sought to determine the levels of complete and partial sensory loss in patients experiencing breakthrough pain and how they change after re-establishment of analgesia.</div></div><div><h3>Methods</h3><div>We conducted an exploratory prospective cohort study to compare the levels of complete and partial sensory loss, to both ice and pinprick, at a time when patients experienced breakthrough pain and after effective analgesia was re-established.</div></div><div><h3>Results</h3><div>We enrolled 30 patients. The median [interquartile range] level of complete sensory loss to <em>ice</em> increased from T12 [L1–T10] while in pain to T10 [T11–T9] after analgesia was re-established. The median level of complete sensory loss to <em>pinprick</em> increased from T12 [L2–T11] while in pain to T11 [T12–T10] after analgesia was re-established. The median level of partial sensory loss to ice and pinprick was above T10 both before and after top-up.</div></div><div><h3>Conclusion</h3><div>Patients experiencing breakthrough pain had a level of complete sensory loss to ice and pinprick below T10. After re-establishment of analgesia, the level of complete sensory loss to ice increased to T10 or above suggesting the level of complete sensory loss to ice may be the preferred mode of assessment of labor epidural analgesia to ensure optimal analgesia. Study registration: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span> (NCT05881395); registered 31st May 2023.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104753"},"PeriodicalIF":2.3,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904439","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 Obstetric Comorbidity Index (OB-CMI) and its association with ICU admission and length of hospital stay in pregnant patients with pulmonary hypertension: a retrospective cohort study (1996–2025)","authors":"S. Ahmed ,&nbsp;E. Liu ,&nbsp;B. Eberhard ,&nbsp;D. Villela-Franyutti ,&nbsp;K. Gray ,&nbsp;D. Drzymalski ,&nbsp;V. Kovacheva","doi":"10.1016/j.ijoa.2025.104751","DOIUrl":"10.1016/j.ijoa.2025.104751","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary hypertension in pregnancy is associated with adverse pregnancy outcomes, such as prolonged hospitalization, intensive care unit (ICU) admission, and high maternal mortality. The Obstetric Comorbidity Index (OB-CMI) assesses maternal risk for these outcomes; however, its predictive power in patients with pulmonary hypertension remains unknown. This study evaluates maternal and neonatal outcomes in patients with pulmonary hypertension and examines whether a higher comorbidity burden is associated with longer hospitalization and ICU admission.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using electronic health records from Mass General Brigham and Tufts Medical Center (1996–July 2025). Patients with pulmonary hypertension and pregnancies beyond 20 weeks’ gestation were identified using the International Classification of Disease-9/10 codes. Data were collected via manual chart review, and descriptive statistics and univariate regression analyses were performed (<em>P</em> &lt; 0.05).</div></div><div><h3>Results</h3><div>Sixty-five pregnancies among 61 patients were identified. The median maternal age was 32.9 (interquartile range 28.9–36.6) years. The maternal mortality rate was 3 %, with both deaths occurring before 2000. Most patients (56.9 %) had cesarean delivery under epidural anesthesia (69.2 %). Median OB-CMI was 9, and median hospitalization was 6 days. Pulmonary artery pressure was associated with prolonged hospitalization (<em>P</em> = 0.004) and ICU admission (<em>P</em> = 0.027). OB-CMI showed borderline association with ICU admission (<em>P</em> = 0.046), but not hospitalization duration (<em>P</em> = 0.580).</div></div><div><h3>Conclusions</h3><div>In patients with pulmonary hypertension, ICU admission and prolonged hospitalization were common and associated with pulmonary arterial pressure but not OB-CMI. Further studies are needed to develop scoring tools specific to pulmonary hypertension patients to improve risk assessment.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104751"},"PeriodicalIF":2.3,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904440","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":"Raising the bar: the next chapter in enhanced recovery after cesarean delivery","authors":"P. Sultan ,&nbsp;L. Bollag ,&nbsp;B. Carvalho ,&nbsp;G. Nelson","doi":"10.1016/j.ijoa.2025.104745","DOIUrl":"10.1016/j.ijoa.2025.104745","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104745"},"PeriodicalIF":2.3,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908438","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":"Serial echocardiographic measurements of cardiac output after spinal anesthesia for scheduled cesarean delivery in healthy patients: a prospective observational study","authors":"M.M. Tawfik,&nbsp;S.M. Hafez,&nbsp;H.A. Abdelmohaymen,&nbsp;O.M. Ismail","doi":"10.1016/j.ijoa.2025.104752","DOIUrl":"10.1016/j.ijoa.2025.104752","url":null,"abstract":"<div><h3>Background</h3><div>Results of studies assessing cardiac output during cesarean delivery are conflicting. Transthoracic echocardiography has been applied in obstetric anesthesia research and clinical practice. We used transthoracic echocardiography to evaluate changes in cardiac output after spinal anesthesia for scheduled cesarean delivery in healthy patients.</div></div><div><h3>Methods</h3><div>This single-arm, prospective observational study was conducted on 60 patients with full-term, singleton pregnancy. Patients received 1000 mL crystalloid coload over 10 minutes; rescue repeated ephedrine bolus for systolic blood pressure &lt;90% (3 mg), 80% (5 mg), and 70% (10 mg) of baseline, respectively; and 10 IU/30 minutes oxytocin infusion. Transthoracic echocardiography was performed at baseline, 10 minutes after intrathecal injection, immediately after delivery, and 1 hour after intrathecal injection. Primary outcome was serial changes in cardiac output over time after spinal anesthesia. Secondary outcomes were serial changes in stroke volume and heart rate, number of patients receiving ephedrine, and incidence of hypotension, severe hypotension, bradycardia, and nausea/vomiting.</div></div><div><h3>Results</h3><div>Mean ± standard devliation baseline cardiac output, stroke volume, and heart rate was 5601 ± 1430 mL/min, 61 ± 14.8 mL, and 92 ± 7.8 beats/min, respectively. Cardiac output and stroke volume increased over time lasting for 1 hour after intrathecal injection. Heart rate increased after spinal anesthesia and after delivery and returned to near baseline 1 h after intrathecal injection.</div></div><div><h3>Conclusions</h3><div>Using crystalloid coload, ephedrine boluses, and oxytocin infusion, cardiac output increased (accompanied with parallel increase in stroke volume) after spinal anesthesia, with highest values immediately after delivery. Transthoracic echocardiography was feasible and applicable for hemodynamic monitoring during cesarean delivery.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104752"},"PeriodicalIF":2.3,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144809339","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":"Inclusion of block efficacy in the WHO surgical safety checklist for maternity patients: a case for enhanced safety and patient-centred care","authors":"D.N. Lucas,&nbsp;J.H. Bamber","doi":"10.1016/j.ijoa.2025.104749","DOIUrl":"10.1016/j.ijoa.2025.104749","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104749"},"PeriodicalIF":2.3,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852437","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}