Anesthetic and obstetric predictors of general anesthesia in urgent or emergent Cesarean delivery: a retrospective case-control study.

Purpose: While regional anesthesia (RA) is considered preferable to general anesthesia (GA) for Cesarean delivery (CD), certain situations necessitate GA. This study reviewed the practice patterns around the use of GA for CD to identify modifiable predictors of GA with the goal of reducing GA rates.

Methods: This was a retrospective, case-control study. Patients undergoing urgent/emergent CD over a 3-year period were identified, from which 102 patients undergoing GA and 102 patients undergoing RA were randomly selected. The data included patient characteristics, obstetrical indications for CD, type/indication of anesthetic, characteristics of airway management (GA group)/neuraxial anesthesia (RA group), and neonatal outcomes.

Results: Abnormal fetal heart rate (aFHR) was the most common obstetrical indication for urgent/emergent CD amongst the cases (39%) and controls (39%). GA administration was most commonly due to "limited time due to maternal/fetal compromise" (56%), followed by "maternal contraindication to RA" (25%) and "inadequate RA" (17%). The most frequent modifiable anesthetic indication for GA was inadequate neuraxial anesthesia (17%). Anesthetic and obstetric predictors for GA included ASA classification [OR 0.11 (0.06-0.21)], emergency code activation [OR 13.55 (1.73-106.40)], failure to progress [OR 0.15 ((0.06-0.36)], labor in a patient scheduled for CD [OR 0.16 (0.05-0.57)], pregnancy-related illness [OR 8.63 (1.06-70.38)], cord/fetal prolapse [14.85(1.90-115.94)], and gestational age (OR 0.86 (0.81-0.92)).

Conclusion: Abnormal fetal heart rate, specifically bradycardia, was the most common obstetrical indication of GA for urgent/emergent CD, while inadequate neuraxial anesthesia was the most  modifiable anesthetic indication. Our data suggest aFHR and cord/fetal prolapse as potentially modifiable risk factors for GA in certain situations.