International journal of obstetric anesthesia最新文献

{"title":"Intrathecal dexmedetomidine for cesarean delivery: a scoping review","authors":"P. Vozzo ,&nbsp;S. Zilber ,&nbsp;R. Landau","doi":"10.1016/j.ijoa.2025.104738","DOIUrl":"10.1016/j.ijoa.2025.104738","url":null,"abstract":"<div><h3>Background</h3><div>Off-label use of intrathecal dexmedetomidine (ITDex) is suggested in recent guidelines for pain management during cesarean delivery. The primary objective of this scoping review was to identify all publications reporting on ITDex for cesarean delivery, and secondarily to evaluate the evidence and characterize reported outcomes associated with its use.</div></div><div><h3>Methods</h3><div>Following PRISMA-Scr guidelines, we searched PubMed and Embase in October 2024 for articles reporting on ITDex for cesarean delivery and conducted a scoping review on randomized controlled trials (RCTs) and observational trials. A chart data with seven questions characterizing the studies and 13 evaluating clinical outcomes was developed.</div></div><div><h3>Results</h3><div>Our search identified 48 publications in English between 2015 and October 2024: 43 RCTs, three observational trials, two case reports/series, resulting in 2,002 patients receiving ITDex (dose ranging 1–35 <span><math><mrow><mi>μ</mi><mi>g</mi><mo>)</mo></mrow></math></span>. Primary outome was stated in 31 (65 %) studies. There were seven dose-ranging studies, one study with fentanyl co-administration, none with morphine co-administration, three compared ITDex vs. clonidine (clonidine dose ranging 15–75 <span><math><mrow><mi>μ</mi><mi>g</mi><mo>)</mo></mrow></math></span>; 35 reported on shivering, 36 on block characteristics (onset and block duration), 38 evaluated postoperative analgesia, nine reported on pain during cesarean delivery.</div></div><div><h3>Discussion</h3><div>Dexmedetomidine may be a valuable intrathecal adjuvant for cesarean delivery but the quality of study design and data reporting in the 48 publications was extremely poor. Though we identified 43 RCTs with at least one arm receiving ITDex, no study incorporated current multimodal opioid-sparing analgesia regimens (administration of intrathecal fentanyl and morphine with or without dexmedetomidine), therefore significant knowledge gaps remain.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104738"},"PeriodicalIF":2.3,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908980","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 experience in the intensive care unit and Post-discharge care: the third report from the MaCriCare study.","authors":"S Cantellow, Ł Balcerzak, A Schyns-van den Berg, D Dabrowska, E Guasch, H Jörnvall, N Lucas, F J Mercier, C F Weiniger, P Krawczyk","doi":"10.1016/j.ijoa.2025.104737","DOIUrl":"https://doi.org/10.1016/j.ijoa.2025.104737","url":null,"abstract":"<p><strong>Background: </strong>Obstetric critical care patients face unique challenges during intensive care unit (ICU) admission, including separation from their newborns and psychological trauma. The ICU environment, primarily designed to support physiological recovery, may not be optimised for maternal experience. Healthcare staff caring for these patients may also experience psychological distress. This is the third report from the MaCriCare study, which examines maternal experiences, follow-up practices, and staff support provisions in ICUs managing obstetric patients across WHO Europe countries.</p><p><strong>Methods: </strong>Between September 1^st 2021 and January 1^st 2022, a multicentre international survey was conducted and included questions on mother-baby contact, breastfeeding support, single-room availability, psychological screening and follow-up, and psychological support for staff in ICUs serving obstetric units. Data from 928 ICUs were analysed.</p><p><strong>Results: </strong>Physical contact was facilitated in 64.9% (n=602) of centres, while breastfeeding support was available in 82.2% (n=763). Single-room accommodation was accessible in 50%. Psychological screening for obstetric patients and follow-up were conducted in 30.6% (n=284) and 33.1% (n=307) of centres, respectively. In 61.7% (n=573) of ICUs, psychological support for staff was available following poor maternal outcomes.</p><p><strong>Conclusion: </strong>While breastfeeding support and some form of mother-baby contact were quite widely available, psychological screening, follow-up, and staff support after poor maternal outcomes remained inconsistent. National-level service mapping is needed to identify best practices and context-specific barriers. The impact of bundled interventions to improve maternal experience during critical illness, and staff support strategies after adverse maternal outcomes, should be formally evaluated in future research.</p>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"104737"},"PeriodicalIF":2.3,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812063","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":"Racial and ethnic disparities in postpartum pain: a systematic review","authors":"R. Craig ,&nbsp;S.E. Nour ,&nbsp;L. Blake ,&nbsp;B. Carvalho ,&nbsp;J. Kua ,&nbsp;J.E. O’Carroll","doi":"10.1016/j.ijoa.2025.104736","DOIUrl":"10.1016/j.ijoa.2025.104736","url":null,"abstract":"<div><h3>Background</h3><div>Racial and ethnic disparities in obstetric analgesia and anaesthesia exist globally. However, little is known about disparities in postpartum pain assessment, intensity, and treatment. These disparities are complex and may be influenced by interlinked factors including social determinants of health. We aimed to review the evidence of disparity related to pain in the postpartum period.</div></div><div><h3>Methods</h3><div>We conducted a systematic review to systematically summarise literature related to racial and ethnic disparity in postpartum pain frequency assessment, severity and opioid prescribing. Relevant observational studies were identified from a previous systematic review and supplementary reference screening.</div></div><div><h3>Results</h3><div>Eight observational studies involving 22,259 patients were included. All included studies were conducted in the United States (n=7) or the United Kingdom (n=1). Five examined pain after caesarean delivery, and three assessed all delivery modes. Studies showed disparities in reporting of pain, with higher pain scores reported by Black and Hispanic patients when compared with White patients. Black patients were also less likely to receive equivalent analgesic medication doses when compared with White patients.</div></div><div><h3>Conclusions</h3><div>Racial and ethnic disparities persist in pain frequency assessment, intensity and analgesic prescribing during the postpartum period. Further research is needed to elucidate the reasons underpinning these disparities, particularly the role of structural and institutional factors, to guide the development of equitable patient-centred approaches to minimise them.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104736"},"PeriodicalIF":2.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703812","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 \"Exploring natural language processing as a tool to improve in obstetric documentation and care.\"","authors":"I Ibrahim Hulchafo, J K Scroggins, S E Harkins, H Moen, M Tadiello, K Cato, A Davoudi, D Goffman, J J Aubey, C Green, M Topaz, V Barcelona","doi":"10.1016/j.ijoa.2025.104730","DOIUrl":"https://doi.org/10.1016/j.ijoa.2025.104730","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"104730"},"PeriodicalIF":2.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812062","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":"Evaluation of the relationship between the Obstetric Comorbidity Index (Ob-CMI) and the Obstetric Quality Of Recovery Score (ObsQoR-11): a prospective observational study","authors":"G. Şensöz Çelik ,&nbsp;F. Gültop,&nbsp;O. Okur","doi":"10.1016/j.ijoa.2025.104735","DOIUrl":"10.1016/j.ijoa.2025.104735","url":null,"abstract":"<div><h3>Background</h3><div>Caesarean delivery is a common surgical procedure associated with significant maternal morbidity and mortality. Delayed postoperative recovery is a critical concern influenced by various factors. This study evaluates whether the Obstetric Comorbidity Index (OB-CMI) predicts postoperative recovery quality, hypothesizing a correlation with the Obstetric Quality of Recovery score (ObsQoR-11).</div></div><div><h3>Methods</h3><div>In our prospective observational study, patients’ demographic data, medical history, ASA score, gravida, parity, gestational age, caesarean delivery category and indication if emergency, OB-CMI, anaesthesia method, intraoperative bleeding and transfusion of blood products, complications, postoperative analgesia use, the duration of hospitalization, the need for admission to intensive care unit and duration (if applicable) and the discharge status were recorded. The primary outcome was the correlation between OB-CMI and ObsQoR-11 scores on postoperative days 1 and 2. Secondary outcomes included comparisons of ObsQoR-11 scores across caesarean categories and anaesthesia techniques.</div></div><div><h3>Results</h3><div>There were 214 patients included in this study. A negative significant correlation was found between the OB-CMI and the ObsQoR-11 score on day 1 (R: -0.286, <em>P</em> &lt;0.001) and day 2 (R: -0.225, <em>P</em> =0.001). The OB-CMI was found to be significantly lower in patients who received neuraxial anaesthesia compared to those who received general anesthesia (<em>P</em> =0.009). The ObsQoR-11 score was found to be significantly lower in patients who received general anaesthesia compared to patients who received neuraxial anaesthesia.</div></div><div><h3>Conclusion</h3><div>A negative correlation between preoperative OB-CMI and postoperative ObsQoR-11 scores suggests that OB-CMI may serve as a valuable preoperative tool for predicting recovery quality in caesarean delivery cases.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104735"},"PeriodicalIF":2.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144739579","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":"Development and validation of a multivariable model for predicting prolonged length of stay following caesarean delivery","authors":"J.E. O’Carroll ,&nbsp;L. Zucco ,&nbsp;E. Warwick ,&nbsp;G. Radcliffe ,&nbsp;S.R. Moonesinghe ,&nbsp;L. Tian ,&nbsp;B. Cai ,&nbsp;K. El-Boghdadly ,&nbsp;N. Guo ,&nbsp;B. Carvalho ,&nbsp;P. Sultan ,&nbsp;on behalf of the ObsQoR Collaborators","doi":"10.1016/j.ijoa.2025.104725","DOIUrl":"10.1016/j.ijoa.2025.104725","url":null,"abstract":"<div><h3>Background</h3><div>Postpartum length of stay is an important metric of recovery following delivery. Predicting prolonged hospital stay could be useful for postpartum care, facilitate patient counselling, allow targeted interventions for modifiable risk factors and support management of maternal bed capacity. Our aim was to develop and internally validate a predictive model for prolonged length of postpartum stay (≥90^th percentile) following caesarean delivery (CD), with the secondary aim to elucidate factors influencing postpartum length of stay.</div></div><div><h3>Methods</h3><div>Following ethics approval in 107 centres in the UK, we conducted a prospective, multicentre study. Eligible patients were enrolled and baseline demographic, anaesthetic, obstetric and medical data were collected on day 1 postpartum and followed by telephone between day 28 and 32 postpartum, with data on length of stay, patient reported outcome measures, recovery, complications and readmission to hospital.</div></div><div><h3>Results</h3><div>Data from 1164 patients who underwent CD were included. A total of 119 patients had a prolonged (≥90^th centile) length of stay (≥102 hours). The receiver operator characteristic curve for a prolonged length of stay under a lasso regularised logistic regression model had an area under the curve of 0.7808, with Obstetric Quality of Recovery (ObsQoR) score, neonatal intensive care admission, gestational age and urgency of CD the most important variables.</div></div><div><h3>Conclusion</h3><div>Using prospectively collected data from a large and diverse national cohort, we developed and validated a model to predict prolonged length of stay following CD in the UK. Further studies are required to determine if targeted interventions can help reduce prolonged length of stay.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104725"},"PeriodicalIF":2.3,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144809338","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 preoperative carbohydrate loading on patients’ anxiety prior to elective caesarean delivery: a randomized controlled trial","authors":"N. Adhithya ,&nbsp;R. Sarna ,&nbsp;V. Ashok ,&nbsp;D. Jain ,&nbsp;R. Chauhan ,&nbsp;A. Arora","doi":"10.1016/j.ijoa.2025.104727","DOIUrl":"10.1016/j.ijoa.2025.104727","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative oral carbohydrate loading prior to elective caesarean delivery has been proposed to enhance recovery after surgery. However, its effect on patients’ preoperative anxiety remains uncertain. This study was, hence, conducted to evaluate the anxiolytic effect of oral complex carbohydrate drink in patients undergoing elective caesarean delivery. We hypothesised that patients who received preoperative oral carbohydrate loading would be less anxious before elective caesarean delivery.</div></div><div><h3>Method</h3><div>Patients undergoing elective caesarean delivery were randomized into two groups. The carbohydrate group (n=50) received 300 mL of iso-osmolar carbohydrate drink the night before surgery and two hours prior to surgery and the control group (n=50) received the same volume of regular water at the same time points. The primary outcome was preoperative anxiety, measured using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Maternal hunger, thirst and nausea, maternal and neonatal blood glucose levels, maternal urinary ketones and postoperative quality of recovery were the secondary objectives.</div></div><div><h3>Results</h3><div>The mean ± standard devation APAIS score before surgery were lower in the carbohydrate group compared to the control group, and the difference was statistically significant (4.56 ± 1.21 vs. 6.36 ± 1.55, mean difference −1.80; 95% CI −2.35 to −1.25; <em>P=</em>0.005). The patients in the carbohydrate group were significantly less hungry and thirsty compared to those in the control group, and had a lower incidence of urinary ketosis and a significantly higher quality of recovery on the first postoperative day.</div></div><div><h3>Conclusion</h3><div>Oral carbohydrate loading reduces preoperative anxiety in patients scheduled for elective caesarean delivery.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104727"},"PeriodicalIF":2.6,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144656909","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":"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":"M. Mohta,&nbsp;R. Kumar,&nbsp;R. Salhotra,&nbsp;S. Kumari,&nbsp;P. Mulodhia","doi":"10.1016/j.ijoa.2025.104729","DOIUrl":"10.1016/j.ijoa.2025.104729","url":null,"abstract":"<div><h3>Background</h3><div>Vasopressors are the mainstay of management of spinal hypotension during caesarean delivery. Norepinephrine, an α- and β-adrenergic agonist, has a lower incidence of bradycardia and is an alternative to phenylephrine. Mephentermine is another such vasopressor and is used in many developing countries. Earlier studies compared norepinephrine and mephentermine using fixed or indirectly calculated doses. The purpose of the current study was to estimate their equipotent doses for the treatment of hypotension.</div></div><div><h3>Methods</h3><div>One hundred healthy parturients with term, uncomplicated, singleton pregnancy undergoing elective caesarean delivery, who developed spinal hypotension, were studied. Hypotension was defined as &gt;20% fall from baseline systolic blood pressure and was treated with a blinded, predetermined dose of norepinephrine or mephentermine. The dose for each patient was determined according to the response in the previous patient using the Narayana rule for up-down sequential allocation. The ED₉₅ and ED₅₀ of norepinephrine and mephentermine boluses and their relative potency ratio were calculated.</div></div><div><h3>Results</h3><div>The ED₉₅ was 7.2 µg (95% confidence interval [CI]: 4.9 to 9.5) for norepinephrine and 1.59 mg (95% CI: 1.43 to 1.75) for mephentermine. The ED₅₀ values were 6.9 µg (95% CI: 6.2 to 7.7) and 1.39 mg (95% CI: 1.33 to 1.46), respectively. The relative ED₉₅ and ED₅₀ potency ratios of norepinephrine to mephentermine were 222 (95% CI: 201 to 242) and 201 (95% CI: 193 to 210), respectively.</div></div><div><h3>Conclusion</h3><div>When used as bolus for treatment of spinal hypotension during elective caesarean delivery, norepinephrine is approximately 220 times more potent than mephentermine; therefore, norepinephrine 8 μg is approximately equivalent to mephentermine 1.7 mg.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104729"},"PeriodicalIF":2.6,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679003","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":"Combined spinal epidural anaesthesia for caesarean delivery of quadruplets: a case report","authors":"S. Talbot ,&nbsp;A. Simpson ,&nbsp;S. Cowan ,&nbsp;R. Hignett","doi":"10.1016/j.ijoa.2025.104726","DOIUrl":"10.1016/j.ijoa.2025.104726","url":null,"abstract":"<div><div>High-order multiple gestation pregnancy is rare, and patients will usually deliver by caesarean delivery (CD), due to the higher incidence of maternal and perinatal morbidity. Anaesthesia for cases involving quadruplets or higher order pregnancy is poorly described: literature review identified only nine cases detailing the conduct of anaesthesia.</div><div>We present a case of spontaneous quad-chorionic quad-amniotic pregnancy in a 34-year-old patient with two prior CDs, who underwent elective CD at 30 + 5 weeks’ gestation under combined spinal epidural (CSE) anaesthesia with a reduced-dose intrathecal hyperbaric bupivacaine 0.5% 2.0 mL and diamorphine 300 μg. Key clinical considerations include aortocaval compression and spinal hypotension, heightened risks of haemorrhage, hypertensive disorders, eclampsia, preterm delivery and perinatal morbidity.</div><div>Despite pregnancy induced hypertension, surgery proceeded uneventfully, with an operating time of 46 minutes and 350 mL blood loss. Four live neonates (weighing 1300–1345 g) were delivered and admitted to the neonatal unit without major morbidity. No additional intraoperative analgesia or epidural anaesthesia top-up was required, and the patient reported high satisfaction with anaesthetic management.</div><div>Postoperative recovery was complicated by maternal hypertension, managed with oral therapy, with hospital discharge on the 4^th postoperative day. At 10 months post-delivery, the quadruplets continue to meet age-adjusted developmental milestones.</div><div>To our knowledge, this is the first reported case in which low dose CSE anaesthesia was provided for a quadruplet or higher-order CD. The case description highlights the challenges associated with high-order multiple gestation pregnancy, and considerations for the anaesthetist in such cases.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104726"},"PeriodicalIF":2.6,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144685439","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 safety of deep sedation for uterine dilation and evacuation in medically complex patients: a retrospective analysis at an urban center (2018–2024)","authors":"H. Nguyen ,&nbsp;N. Spence ,&nbsp;E. Liu ,&nbsp;R. Cannon ,&nbsp;E. Dienes ,&nbsp;M. Norris ,&nbsp;E. Woodhams ,&nbsp;R. Achu-Lopes","doi":"10.1016/j.ijoa.2025.104728","DOIUrl":"10.1016/j.ijoa.2025.104728","url":null,"abstract":"<div><h3>Background</h3><div>Data on the safety of dilation and evacuation performed under deep sedation are limited for patients beyond 24 0/7 weeks’ gestational age, particularly in populations with comorbidities including obesity or substance use disorder. This study evaluated the incidence of anesthesia-related complications during dilation and evacuations under intravenous deep sedation in a medically complex patient cohort including pregnancy termination beyond 24 0/7 weeks’ gestation.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective cohort analysis of elective dilation and evacuations performed under deep sedation between 12 0/7 to 27 6/7 weeks’ gestation. The primary outcome was the incidence of periprocedural anesthetic-related complications necessitating endotracheal intubation. Secondary outcomes included hypoxemic episodes requiring intervention by an anesthesiologist. A logistic regression analysis was used to determine the relationship between gestational age and all hypoxemic episodes.</div></div><div><h3>Results</h3><div>Of the 1,165 dilation and evacuations performed under deep sedation, 101 (8.7%) were conducted at greater than 24 0/7 weeks gestation, 397 (34.1%) were performed on patients with body mass indices above 30 kg/m², and 104 (8.9%) were performed in patients with substance use disorder. One case of emesis at 18 5/7 weeks’ gestation necessitated endotracheal intubation (0.09% [95% CI: 0.012 to 0.6]). Three cases of hypoxemic episodes required intervention (0.3% [95% CI: 0.08 to 0.8]).</div></div><div><h3>Conclusion</h3><div>Intravenous deep sedation for dilation and evacuation is associated with a low incidence of anesthetic-related complications in medically complex patients, including terminations beyond 24 0/7 weeks.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"64 ","pages":"Article 104728"},"PeriodicalIF":2.6,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679002","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}