Pub Date : 2026-02-01Epub Date: 2025-10-23DOI: 10.1016/j.ijoa.2025.104806
A Ashour , B. Roberts , K. Turner , K Bhatia , M. Columb , on behalf of Group of Obstetric Anaesthetist’s of Lancashire, Greater Manchester, and Mersey (GOAL-GM) Study Collaborators
Introduction
The literature is scarce on how to perform general anaesthesia for caesarean delivery in women with class 3 obesity.
Methods
In this retrospective study, we evaluated characteristics related to the conduct of general anaesthesia for elective and non-elective caesarean delivery in 56 pregnant women with class 3 obesity in nine maternity units across the north-west of England, between 2022–2023. We analysed the pre-oxygenation technique, anaesthetic agents utilised, documented hypoxia (SpO2 ≤ 94%) occurrence, and the frequency of difficult intubation.
Results
A de novo facemask technique was used for preoxygenation in 82% of cases, whilst high-flow nasal oxygen was utilised in 13.2%. Propofol was utilised in 78% whilst an opioid predelivery was administered to 55% of women. Rocuronium was the preferred neuromuscular blocking agent to facilitate endotracheal intubation in 68% of cases. Video laryngoscopy was employed in 68% whilst hypoxia was documented in 25% of women. Difficult intubation occurred in one woman (1.8%, 95% CI 0.0–9.6), and no failed intubations were recorded.
Conclusion
Our study highlights variability in the administration of general anaesthesia for caesarean delivery in women with class 3 obesity, and frequent occurrence of hypoxia. Further research is needed to determine optimal preoxygenation strategy and general anaesthesia technique to minimise hypoxia and difficult intubation risk in this cohort.
关于3级肥胖妇女剖宫产时如何实施全身麻醉的文献很少。方法在这项回顾性研究中，我们评估了2022-2023年间英格兰西北部9个产科单位56名3级肥胖孕妇择期和非择期剖宫产全麻的相关特征。我们分析了预充氧技术、麻醉药物的使用、记录的缺氧（SpO2≤94%）的发生以及插管困难的频率。结果82%的病例采用从头面罩技术进行预充氧，13.2%的病例采用高流量鼻氧。78%的妇女使用异丙酚，55%的妇女在分娩前使用阿片类药物。在68%的病例中，罗库溴铵是促进气管插管的首选神经肌肉阻断剂。68%的女性采用视频喉镜检查，25%的女性有缺氧记录。1名女性出现插管困难（1.8%,95% CI 0.0-9.6），无插管失败记录。结论：我们的研究强调了3级肥胖和经常发生缺氧的妇女剖宫产全麻给药的可变性。需要进一步的研究来确定最佳的预充氧策略和全身麻醉技术，以尽量减少缺氧和插管困难的风险。
{"title":"General anaesthesia for caesarean delivery in women with class 3 obesity: case series from nine hospitals across the north-west of England (2022–2023)","authors":"A Ashour , B. Roberts , K. Turner , K Bhatia , M. Columb , on behalf of Group of Obstetric Anaesthetist’s of Lancashire, Greater Manchester, and Mersey (GOAL-GM) Study Collaborators","doi":"10.1016/j.ijoa.2025.104806","DOIUrl":"10.1016/j.ijoa.2025.104806","url":null,"abstract":"<div><h3>Introduction</h3><div>The literature is scarce on how to perform general anaesthesia for caesarean delivery in women with class 3 obesity.</div></div><div><h3>Methods</h3><div>In this retrospective study, we evaluated characteristics related to the conduct of general anaesthesia for elective and non-elective caesarean delivery in 56 pregnant women with class 3 obesity in nine maternity units across the north-west of England, between 2022–2023. We analysed the pre-oxygenation technique, anaesthetic agents utilised, documented hypoxia (SpO<sub>2</sub> ≤ 94%) occurrence, and the frequency of difficult intubation.</div></div><div><h3>Results</h3><div>A de novo facemask technique was used for preoxygenation in 82% of cases, whilst high-flow nasal oxygen was utilised in 13.2%. Propofol was utilised in 78% whilst an opioid predelivery was administered to 55% of women. Rocuronium was the preferred neuromuscular blocking agent to facilitate endotracheal intubation in 68% of cases. Video laryngoscopy was employed in 68% whilst hypoxia was documented in 25% of women. Difficult intubation occurred in one woman (1.8%, 95% CI 0.0–9.6), and no failed intubations were recorded.</div></div><div><h3>Conclusion</h3><div>Our study highlights variability in the administration of general anaesthesia for caesarean delivery in women with class 3 obesity, and frequent occurrence of hypoxia. Further research is needed to determine optimal preoxygenation strategy and general anaesthesia technique to minimise hypoxia and difficult intubation risk in this cohort.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104806"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462778","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}
Pub Date : 2026-02-01Epub Date: 2025-10-27DOI: 10.1016/j.ijoa.2025.104812
A. Maeda , Y. Mazda , R. Ohara , S. Tanabe , M. Tokiwa , W. Camann
{"title":"In response to Ogawa et al on editorial “Obstetric anesthesia in Japan: An existential crisis in need of an intervention”","authors":"A. Maeda , Y. Mazda , R. Ohara , S. Tanabe , M. Tokiwa , W. Camann","doi":"10.1016/j.ijoa.2025.104812","DOIUrl":"10.1016/j.ijoa.2025.104812","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104812"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145451857","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}
Pub Date : 2026-02-01Epub Date: 2025-11-24DOI: 10.1016/j.ijoa.2025.104822
Noor Joudi , Nidhee S. Reddy , Elizabeth B. Sherwin , Metabel Markwei , Janet Hurtado , Samantha L. Simpson , Jordan J. Burgess , Stephanie A. Leonard , Miriam Schultz , Brendan Carvalho , Pervez Sultan , Katherine Bianco , Danielle M. Panelli
Background
Adverse childhood experiences (ACEs) are linked to higher opioid use and pain in non-pregnant populations, yet their effect after cesarean delivery is unclear. We evaluated whether ACEs influence postpartum opioid use and pain following cesarean.
Methods
We prospectively enrolled English or Spanish speaking women undergoing scheduled or intrapartum cesarean delivery under neuraxial anesthesia (2023–2024).The exposure was ≥ 1 ACEs, assessed via a validated questionnaire 24–48 h post-delivery. The primary outcome was opioid use (0–48 h) post-delivery in milligram morphine equivalents (MME). Pain was measured using the Short-Form Brief Pain Inventory (SF-BPI) 24–48 h postpartum and average numerical rating scale pain scores (recorded every 4 h). We used multivariable modified Poisson regression models to evaluate the association between ACEs and any opioid use, and multinomial regression to examine opioid dose quartiles.
Results
Among 129 participants, 53 (41%) reported ≥ 1 ACEs. Women with ACEs were more likely to use opioids in the first 48 h postpartum than those without ACEs (89% vs. 59%, adjusted risk ratio [aRR] 1.52; CI 1.20, 1.91). ACEs were also associated with higher opioid dosage across quartiles: 2nd [adjusted odds ratio (aOR) 8.60; CI 2.47, 29.9], 3rd (aOR 5.74; CI 1.54–21.4), and 4th (highest) [aOR 4.54; CI 1.30, 15.9] vs. the lowest quartile. Numerical rating scale pain scores were higher among women with ACEs (3/10 vs. 2/10, P = 0.037), as were SF-BPI worst pain scores (7/10 vs. 6/10, P = 0.029).
Conclusions
Adverse childoohd experiences were common and associated with higher opioid consumption and greater pain after cesarean delivery, supporting trauma-informed approaches to postpartum analgesia.
{"title":"Adverse childhood experiences and post-cesarean pain and in-hospital opioid use: a prospective cohort study","authors":"Noor Joudi , Nidhee S. Reddy , Elizabeth B. Sherwin , Metabel Markwei , Janet Hurtado , Samantha L. Simpson , Jordan J. Burgess , Stephanie A. Leonard , Miriam Schultz , Brendan Carvalho , Pervez Sultan , Katherine Bianco , Danielle M. Panelli","doi":"10.1016/j.ijoa.2025.104822","DOIUrl":"10.1016/j.ijoa.2025.104822","url":null,"abstract":"<div><h3>Background</h3><div>Adverse childhood experiences (ACEs) are linked to higher opioid use and pain in non-pregnant populations, yet their effect after cesarean delivery is unclear. We evaluated whether ACEs influence postpartum opioid use and pain following cesarean.</div></div><div><h3>Methods</h3><div>We prospectively enrolled English or Spanish speaking women undergoing scheduled or intrapartum cesarean delivery under neuraxial anesthesia (2023–2024).The exposure was ≥ 1 ACEs, assessed via a validated questionnaire 24–48 h post-delivery. The primary outcome was opioid use (0–48 h) post-delivery in milligram morphine equivalents (MME). Pain was measured using the Short-Form Brief Pain Inventory (SF-BPI) 24–48 h postpartum and average numerical rating scale pain scores (recorded every 4 h). We used multivariable modified Poisson regression models to evaluate the association between ACEs and any opioid use, and multinomial regression to examine opioid dose quartiles.</div></div><div><h3>Results</h3><div>Among 129 participants, 53 (41%) reported ≥ 1 ACEs. Women with ACEs were more likely to use opioids in the first 48 h postpartum than those without ACEs (89% vs. 59%, adjusted risk ratio [aRR] 1.52; CI 1.20, 1.91). ACEs were also associated with higher opioid dosage across quartiles: 2<sup>nd</sup> [adjusted odds ratio (aOR) 8.60; CI 2.47, 29.9], 3<sup>rd</sup> (aOR 5.74; CI 1.54–21.4), and 4<sup>th</sup> (highest) [aOR 4.54; CI 1.30, 15.9] vs. the lowest quartile. Numerical rating scale pain scores were higher among women with ACEs (3/10 vs. 2/10, <em>P</em> = 0.037), as were SF-BPI worst pain scores (7/10 vs. 6/10, <em>P</em> = 0.029).</div></div><div><h3>Conclusions</h3><div>Adverse childoohd experiences were common and associated with higher opioid consumption and greater pain after cesarean delivery, supporting trauma-informed approaches to postpartum analgesia.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104822"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145723353","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}
Pub Date : 2026-02-01Epub Date: 2025-09-23DOI: 10.1016/j.ijoa.2025.104777
G. Thomas, A. Dhadda, Y. Metodiev
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.
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.
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.
{"title":"Acute obstetric coagulopathy without severe postpartum haemorrhage following medical termination of pregnancy presenting as gingival bleeding: a case report","authors":"G. Thomas, A. Dhadda, 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":"2026-02-01","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}
Pub Date : 2026-02-01Epub Date: 2025-11-17DOI: 10.1016/j.ijoa.2025.104820
S.L. Armstrong , A.A. Berger , S. Zec, M. Douek, K. Li, M.C. Borrelli, Y. Li, P.E. Hess
Background
Dexmedetomidine is a highly selective alpha2-adrenoceptor agonist with anxiolytic, sedative, and analgesic properties. The use of this medication in obstetric anesthesia has increased with publications describing intravenous (IV) use for shivering, and epidural and intrathecal use for anesthesia and analgesia. Limited data exists on the frequency of adverse events during clinical use. We reviewed our use of dexmedetomidine in the peripartum period to identify specific indications and maternal adverse events
Methods
We performed a retrospective review of dexmedetomidine administration during labor and delivery over three years (2022–2024). The route of administration, indication and doses were collected and all identifiable adverse events related to dexmedetomidine administration were recorded.
Results
There were 1,177 records available for review and 1,100 were analyzed. Dexmedetomidine was administered most often for augmentation of cesarean anesthesia, treatment of breakthrough pain during labor, and for shivering. Maternal heart rate abnormalities were noted in 47 cases (6.1%; 95% CI 4.5-8.0), bradycardia in 16 cases (2.1%; 95% CI 1.2-3.4), hypotension in 57 cases (7.2%; 95% CI 5.5-9.3), and sedation in 9 cases (1.2% 95% CI 0.6-2.3). Maternal adverse events were less common after neuraxial administration compared with IV.
Conclusions
Our clinical experience demonstrated maternal adverse events that might be traced to the administration of either IV or neuraxial dexmedetomidine, which were more common after IV administration. As adverse events are likely to be dose-related, we would recommend starting with the lowest appropriate dose and titrating to the desired effect.
背景：右美托咪定是一种高度选择性的α - 2肾上腺素能受体激动剂，具有抗焦虑、镇静和镇痛作用。这种药物在产科麻醉中的使用越来越多，出版物描述了静脉注射（IV）用于颤抖，硬膜外和鞘内用于麻醉和镇痛。关于临床使用中不良事件发生频率的数据有限。我们回顾了我们在围产期使用右美托咪定的情况，以确定具体的适应症和产妇不良事件。方法：我们回顾性回顾了三年来（2022-2024）在分娩和分娩过程中使用右美托咪定的情况。收集给药途径、适应症和剂量，并记录所有可识别的与右美托咪定给药相关的不良事件。结果：有1177条记录可供回顾，1100条记录被分析。右美托咪定最常用于增强剖宫产麻醉，治疗分娩时突发性疼痛和颤抖。产妇心率异常47例（6.1%,95% CI 4.5-8.0），心动过缓16例（2.1%,95% CI 1.2-3.4），低血压57例（7.2%,95% CI 5.5-9.3），镇静9例（1.2%,95% CI 0.6-2.3）。与静脉给药相比，静脉给药后母体不良事件较少。结论：我们的临床经验表明，母体不良事件可能与静脉给药或静脉给药有关，静脉给药后母体不良事件更为常见。由于不良事件可能与剂量有关，我们建议从最低适当剂量开始，并逐渐达到预期效果。
{"title":"Maternal hemodynamic effects associated with intravenous and neuraxial dexmedetomidine during labor and cesarean delivery: a single center retrospective study (2021–2024)","authors":"S.L. Armstrong , A.A. Berger , S. Zec, M. Douek, K. Li, M.C. Borrelli, Y. Li, P.E. Hess","doi":"10.1016/j.ijoa.2025.104820","DOIUrl":"10.1016/j.ijoa.2025.104820","url":null,"abstract":"<div><h3>Background</h3><div>Dexmedetomidine is a highly selective alpha<sub>2</sub>-adrenoceptor agonist with anxiolytic, sedative, and analgesic properties. The use of this medication in obstetric anesthesia has increased with publications describing intravenous (IV) use for shivering, and epidural and intrathecal use for anesthesia and analgesia. Limited data exists on the frequency of adverse events during clinical use. We reviewed our use of dexmedetomidine in the peripartum period to identify specific indications and maternal adverse events</div></div><div><h3>Methods</h3><div>We performed a retrospective review of dexmedetomidine administration during labor and delivery over three years (2022–2024). The route of administration, indication and doses were collected and all identifiable adverse events related to dexmedetomidine administration were recorded.</div></div><div><h3>Results</h3><div>There were 1,177 records available for review and 1,100 were analyzed. Dexmedetomidine was administered most often for augmentation of cesarean anesthesia, treatment of breakthrough pain during labor, and for shivering. Maternal heart rate abnormalities were noted in 47 cases (6.1%; 95% CI 4.5-8.0), bradycardia in 16 cases (2.1%; 95% CI 1.2-3.4), hypotension in 57 cases (7.2%; 95% CI 5.5-9.3), and sedation in 9 cases (1.2% 95% CI 0.6-2.3). Maternal adverse events were less common after neuraxial administration compared with IV.</div></div><div><h3>Conclusions</h3><div>Our clinical experience demonstrated maternal adverse events that might be traced to the administration of either IV or neuraxial dexmedetomidine, which were more common after IV administration. As adverse events are likely to be dose-related, we would recommend starting with the lowest appropriate dose and titrating to the desired effect.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104820"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604174","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}
Pub Date : 2026-02-01Epub Date: 2025-12-06DOI: 10.1016/j.ijoa.2025.104832
A. Malin, G. Garvey, H. McNamara
Background
Preeclampsia is a multisystem hypertensive disorder of pregnancy associated with coagulation abnormalities. Haemostatic testing aids decision making about mode of anaesthesia. Current UK guidelines consider the risk of neuraxial anaesthesia is increased if laboratory platelet count is < 100,000/μL. However, laboratory tests are limited by turnaround time and do not evaluate platelet function. This prospective case-control study investigated the utility of point-of-care testing with rotational thromboelastometry and platelet aggregometry to predict laboratory results in patients with preeclampsia.
Method
Seventy-one patients with preeclampsia and 57 pregnant control patients were included. Thromboelastometry and platelet aggregometry parameters were compared with laboratory tests. Repeat tests were performed at a median of 11 h in 55 patients with preeclampsia.
Results
Four point of care-derived parameters were significantly lower in preeclampsia patients with platelet count < 100,000/μL than those > 100,000/μL; EXTEM A5, clot elasticity from platelets (CEplatelet), PLTEM (EXTEM A5-FIBTEM A5) and ADP-induced platelet aggregation. These parameters showed high negative but low positive predictive values for platelet count < 100,000/μL, with the highest negative predictive value of 1.0 (95% CI 0.96, 1.0; P < 0.0001) for PLTEM. Serial testing in 55 patients with preeclampsia showed reclassification of neuraxial anaesthesia risk in two cases according to platelet count.
Conclusion
This study has identified thromboelastometry and aggregometry parameters that may be useful in rapidly ruling out a platelet count < 100,000/μL in patients with preeclampsia, a threshold associated with increased risk of neuraxial haematoma. However, a limited positive predictive ability and relatively small sample size warrants further research before routine implementation.
背景子痫前期是一种与凝血异常相关的妊娠多系统高血压疾病。止血试验有助于决定麻醉方式。目前的英国指南认为，如果实验室血小板计数为10万/μL，则神经轴麻醉的风险增加。然而，实验室测试受周转时间的限制，不能评估血小板功能。这项前瞻性病例对照研究调查了旋转血栓弹性测定法和血小板聚集法在预测子痫前期患者实验室结果中的应用。方法选取71例先兆子痫患者和57例妊娠对照。将血栓弹性测量和血小板聚集参数与实验室测试进行比较。在55例先兆子痫患者中，平均11小时进行重复试验。结果血小板计数≥10万/μL的子痫前期患者4项监护指标均低于血小板计数≥10万/μL的子痫前期患者；EXTEM A5，血小板凝块弹性（ce血小板），PLTEM （EXTEM A5- fitem A5）和adp诱导的血小板聚集。这些参数对血小板计数（10万/μL）的阴性预测值高，阳性预测值低，对PLTEM的阴性预测值最高为1.0 （95% CI 0.96, 1.0; P < 0.0001）。55例先兆子痫患者的系列试验显示，根据血小板计数，两例患者的轴向麻醉风险被重新分类。结论：本研究确定了血小板弹性测量和聚集参数，可用于快速排除先兆子痫患者血小板计数（10万/μL），这一阈值与轴状血肿风险增加有关。然而，有限的阳性预测能力和相对较小的样本量值得在常规实施前进一步研究。
{"title":"Platelet parameters in preeclampsia: comparing rotational thromboelastometry and platelet aggregometry with standard laboratory tests","authors":"A. Malin, G. Garvey, H. McNamara","doi":"10.1016/j.ijoa.2025.104832","DOIUrl":"10.1016/j.ijoa.2025.104832","url":null,"abstract":"<div><h3>Background</h3><div>Preeclampsia is a multisystem hypertensive disorder of pregnancy associated with coagulation abnormalities. Haemostatic testing aids decision making about mode of anaesthesia. Current UK guidelines consider the risk of neuraxial anaesthesia is increased if laboratory platelet count is < 100,000/μL. However, laboratory tests are limited by turnaround time and do not evaluate platelet function. This prospective case-control study investigated the utility of point-of-care testing with rotational thromboelastometry and platelet aggregometry to predict laboratory results in patients with preeclampsia.</div></div><div><h3>Method</h3><div>Seventy-one patients with preeclampsia and 57 pregnant control patients were included. Thromboelastometry and platelet aggregometry parameters were compared with laboratory tests. Repeat tests were performed at a median of 11 h in 55 patients with preeclampsia.</div></div><div><h3>Results</h3><div>Four point of care-derived parameters were significantly lower in preeclampsia patients with platelet count < 100,000/μL than those > 100,000/μL; EXTEM A5, clot elasticity from platelets (CE<sub>platelet</sub>), PLTEM (EXTEM A5-FIBTEM A5) and ADP-induced platelet aggregation. These parameters showed high negative but low positive predictive values for platelet count < 100,000/μL, with the highest negative predictive value of 1.0 (95% CI 0.96, 1.0; <em>P</em> < 0.0001) for PLTEM. Serial testing in 55 patients with preeclampsia showed reclassification of neuraxial anaesthesia risk in two cases according to platelet count.</div></div><div><h3>Conclusion</h3><div>This study has identified thromboelastometry and aggregometry parameters that may be useful in rapidly ruling out a platelet count < 100,000/μL in patients with preeclampsia, a threshold associated with increased risk of neuraxial haematoma. However, a limited positive predictive ability and relatively small sample size warrants further research before routine implementation.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104832"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145836675","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}
Pub Date : 2026-02-01Epub Date: 2025-10-25DOI: 10.1016/j.ijoa.2025.104809
R. Abu Shqara , L. Rozenkrantz , S. Nahir Biderman , Y. Perez , T. Domfrocht , A. Aiob , N. Ganem , L. Lowenstein , M. Frank Wolf
Background
Labor epidural analgesia (LEA) is widely used for pain relief, but the impact of midwives’ attitudes and experience on its administration is underexplored. We examined whether midwives’ attitudes and experience influence LEA use among their patients.
Methods
This survey-based cohort study included 10,080 term singleton vaginal deliveries (2020–2025) at a tertiary center. Each case was linked to the midwife who attended the patient at the time of admission to the delivery room and provided the initial care. Thirty-five midwives completed a 10-item attitude questionnaire toward LEA, analyzed by principal component analysis to derive the LEA-related concern (PC1) and perceived external influence (PC2) scores. Multivariable regression, stratified by parity, examined associations between midwife characteristics and LEA use, adjusting for maternal and clinical covariates.
Results
The LEA rate was 63.5%, and was more common among primiparas, with admission with lower cervical dilation, and with oxytocin induction (P < 0.001). LEA use decreased with midwife experience, from 70.0% when midwifes’ experience was < 5 years to 55.5% when midwifes’ experience was > 20 years (P < 0.001). In multivariable models, each additional year of experience was independently associated with reduced odds of LEA (primiparas: OR 0.83, 95% CI: 0.76–0.92; multiparas: OR 0.84, 95% CI: 0.79–0.89). Higher LEA-related concern scores (PC1) were associated with lower odds of LEA among primiparas (OR 0.94, 95%CI: 0.89–0.99) but not multiparas.
Conclusions
Midwives’ clinical experience and attitudes toward LEA influence its use in the deliveries they attend, particularly among primiparous patients. These findings underscore the importance of evidence-based counseling to promote informed intrapartum pain management.
{"title":"Impact of midwife clinical experience and survey-based attitudes towards labor epidural analgesia on utilization rates in pregnant patients: a survey-based cohort study","authors":"R. Abu Shqara , L. Rozenkrantz , S. Nahir Biderman , Y. Perez , T. Domfrocht , A. Aiob , N. Ganem , L. Lowenstein , M. Frank Wolf","doi":"10.1016/j.ijoa.2025.104809","DOIUrl":"10.1016/j.ijoa.2025.104809","url":null,"abstract":"<div><h3>Background</h3><div>Labor epidural analgesia (LEA) is widely used for pain relief, but the impact of midwives’ attitudes and experience on its administration is underexplored. We examined whether midwives’ attitudes and experience influence LEA use among their patients.</div></div><div><h3>Methods</h3><div>This survey-based cohort study included 10,080 term singleton vaginal deliveries (2020–2025) at a tertiary center. Each case was linked to the midwife who attended the patient at the time of admission to the delivery room and provided the initial care. Thirty-five midwives completed a 10-item attitude questionnaire toward LEA, analyzed by principal component analysis to derive the LEA-related concern (PC1) and perceived external influence (PC2) scores. Multivariable regression, stratified by parity, examined associations between midwife characteristics and LEA use, adjusting for maternal and clinical covariates.</div></div><div><h3>Results</h3><div>The LEA rate was 63.5%, and was more common among primiparas, with admission with lower cervical dilation, and with oxytocin induction (<em>P</em> < 0.001). LEA use decreased with midwife experience, from 70.0% when midwifes’ experience was < 5 years to 55.5% when midwifes’ experience was > 20 years (<em>P</em> < 0.001). In multivariable models, each additional year of experience was independently associated with reduced odds of LEA (primiparas: OR 0.83, 95% CI: 0.76–0.92; multiparas: OR 0.84, 95% CI: 0.79–0.89). Higher LEA-related concern scores (PC1) were associated with lower odds of LEA among primiparas (OR 0.94, 95%CI: 0.89–0.99) but not multiparas.</div></div><div><h3>Conclusions</h3><div>Midwives’ clinical experience and attitudes toward LEA influence its use in the deliveries they attend, particularly among primiparous patients. These findings underscore the importance of evidence-based counseling to promote informed intrapartum pain management.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104809"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409054","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}
Pub Date : 2026-02-01Epub Date: 2025-12-16DOI: 10.1016/j.ijoa.2025.104838
C. Murphy, M. Melvin
Malignant hyperthermia (MH) is a rare, potentially life-threatening pharmacogenetic disorder most commonly associated with variants in the ryanodine receptor 1 gene (RYR1). Obstetric patients with undetermined risk of MH present distinct challenges, as the potential need for urgent delivery limits opportunities for anaesthetic preparation and necessitates a high level of multidisciplinary readiness.
We describe the perioperative management of a 32-year-old woman heterozygous for a RYR1 splicing variant who underwent an elective caesarean delivery at 39 weeks’ gestation following an in vitro fertilisation pregnancy. Her partner is a heterozygous carrier of the same pathogenic RYR1 variant, giving the fetus a 25% risk of severe autosomal-recessive myopathy, 50% chance of being an asymptomatic carrier, and an undetermined risk of malignant hyperthermia susceptibility. The patient had an undetermined risk of MH, in the absence of confirmatory testing. Early antenatal anaesthetic assessment enabled comprehensive risk evaluation and multidisciplinary planning. A detailed perioperative management strategy was implemented, incorporating early communication pathways, preparation of a trigger-free theatre, and development of a patient-specific MH prevention pack. Simulation-based multidisciplinary training was undertaken to enhance team preparedness and streamline trigger-free anaesthetic setup. An uncomplicated caesarean delivery was performed under spinal anaesthesia in a pre-prepared trigger-free environment. The patient was discharged home on the third post-operative day with a baby boy.
This case underscores the importance of early antenatal identification, multidisciplinary collaboration, and simulation-based training in developing structured emergency and personalised anaesthetic strategies. Given the rarity of such cases, and the absence of obstetric specific UK or Irish guidelines, proactive institutional preparedness remains essential to ensure safe obstetric outcomes in patients with undetermined risk of MH.
{"title":"Anaesthetic considerations for delivery in an obstetric patient with a RYR1 gene variant: a case report","authors":"C. Murphy, M. Melvin","doi":"10.1016/j.ijoa.2025.104838","DOIUrl":"10.1016/j.ijoa.2025.104838","url":null,"abstract":"<div><div>Malignant hyperthermia (MH) is a rare, potentially life-threatening pharmacogenetic disorder most commonly associated with variants in the ryanodine receptor 1 gene (RYR1). Obstetric patients with undetermined risk of MH present distinct challenges, as the potential need for urgent delivery limits opportunities for anaesthetic preparation and necessitates a high level of multidisciplinary readiness.</div><div>We describe the perioperative management of a 32-year-old woman heterozygous for a RYR1 splicing variant who underwent an elective caesarean delivery at 39 weeks’ gestation following an in vitro fertilisation pregnancy. Her partner is a heterozygous carrier of the same pathogenic RYR1 variant, giving the fetus a 25% risk of severe autosomal-recessive myopathy, 50% chance of being an asymptomatic carrier, and an undetermined risk of malignant hyperthermia susceptibility. The patient had an undetermined risk of MH, in the absence of confirmatory testing. Early antenatal anaesthetic assessment enabled comprehensive risk evaluation and multidisciplinary planning. A detailed perioperative management strategy was implemented, incorporating early communication pathways, preparation of a trigger-free theatre, and development of a patient-specific MH prevention pack. Simulation-based multidisciplinary training was undertaken to enhance team preparedness and streamline trigger-free anaesthetic setup. An uncomplicated caesarean delivery was performed under spinal anaesthesia in a pre-prepared trigger-free environment. The patient was discharged home on the third post-operative day with a baby boy.</div><div>This case underscores the importance of early antenatal identification, multidisciplinary collaboration, and simulation-based training in developing structured emergency and personalised anaesthetic strategies. Given the rarity of such cases, and the absence of obstetric specific UK or Irish guidelines, proactive institutional preparedness remains essential to ensure safe obstetric outcomes in patients with undetermined risk of MH.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104838"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786645","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}
Pub Date : 2026-02-01Epub Date: 2025-10-14DOI: 10.1016/j.ijoa.2025.104794
V.A. Eley , S Okano , S. Lawrence , S. Bertrand , A. Kothari , D Whitcombe , M.G. Godsall
Background
Optimising post-caesarean analgesia is important to facilitate quality maternal recovery. We described post-caesarean analgesia and patient satisfaction to determine alignment with expert recommendations and described practice changes over time.
Methods
This retrospective multisite study included patients undergoing caesarean delivery in public hospitals in Queensland. We evaluated the use of long-acting neuraxial opioid; additional regional analgesia techniques; simple analgesics and “as-required” oral opioids for rescue and patient satisfaction. Differences between the first 6-month and last 7-month periods were compared.
Results
Of 27,867 patients reported between January 2019 and July 2022, 25,531 (91.6%) received neuraxial anaesthesia. Of those, 12 341 (48.3%) received neuraxial morphine/hydromorphone. Regional techniques were more common after general anaesthesia (GA, primary or secondary) compared with neuraxial anaesthesia (adjusted P < 0.001). Paracetamol was used in 27,754 (99.6%) and nonsteroidal anti-inflammatory drugs (NSAIDs) in 26,231 (94.1%). The most common oral analgesia combination was paracetamol, NSAIDs, immediate-release oxycodone and slow-release oxycodone (8035, 30.6%). Of all patients, 25,294 (90.8%) were satisfied/very satisfied and more patients having neuraxial anaesthesia were satisfied/very satisfied (adjusted P < 0.001).
Use of long-acting neuraxial opioid increased significantly from 1544 of 3242 (48%) to 2847 of 4307 (66%) during the interval studied (P < 0.001). Use of slow-release oxycodone decreased from 2403 (67%) to 2255 (48%). Buprenorphine use increased from 181 (5%) to 981 (21%) and tramadol from 1299 (36%) to 2258 (48%), all P < 0.001.
Conclusions
Use of long-acting neuraxial opioid and oral atypical opioids increased, while commonly prescribed slow-release opioid declined with time. Compliance with opioid-sparing principles can be significantly improved.
{"title":"Post-caesarean analgesia – a multicentre retrospective analysis comparing practices in Queensland, Australia (2019–2022)","authors":"V.A. Eley , S Okano , S. Lawrence , S. Bertrand , A. Kothari , D Whitcombe , M.G. Godsall","doi":"10.1016/j.ijoa.2025.104794","DOIUrl":"10.1016/j.ijoa.2025.104794","url":null,"abstract":"<div><h3>Background</h3><div>Optimising post-caesarean analgesia is important to facilitate quality maternal recovery. We described post-caesarean analgesia and patient satisfaction to determine alignment with expert recommendations and described practice changes over time.</div></div><div><h3>Methods</h3><div>This retrospective multisite study included patients undergoing caesarean delivery in public hospitals in Queensland. We evaluated the use of long-acting neuraxial opioid; additional regional analgesia techniques; simple analgesics and “as-required” oral opioids for rescue and patient satisfaction. Differences between the first 6-month and last 7-month periods were compared.</div></div><div><h3>Results</h3><div>Of 27,867 patients reported between January 2019 and July 2022, 25,531 (91.6%) received neuraxial anaesthesia. Of those, 12 341 (48.3%) received neuraxial morphine/hydromorphone. Regional techniques were more common after general anaesthesia (GA, primary or secondary) compared with neuraxial anaesthesia (adjusted <em>P</em> < 0.001). Paracetamol was used in 27,754 (99.6%) and nonsteroidal anti-inflammatory drugs (NSAIDs) in 26,231 (94.1%). The most common oral analgesia combination was paracetamol, NSAIDs, immediate-release oxycodone and slow-release oxycodone (8035, 30.6%). Of all patients, 25,294 (90.8%) were satisfied/very satisfied and more patients having neuraxial anaesthesia were satisfied/very satisfied (adjusted <em>P</em> < 0.001).</div><div>Use of long-acting neuraxial opioid increased significantly from 1544 of 3242 (48%) to 2847 of 4307 (66%) during the interval studied (<em>P</em> < 0.001). Use of slow-release oxycodone decreased from 2403 (67%) to 2255 (48%). Buprenorphine use increased from 181 (5%) to 981 (21%) and tramadol from 1299 (36%) to 2258 (48%), all <em>P</em> < 0.001.</div></div><div><h3>Conclusions</h3><div>Use of long-acting neuraxial opioid and oral atypical opioids increased, while commonly prescribed slow-release opioid declined with time. Compliance with opioid-sparing principles can be significantly improved.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"65 ","pages":"Article 104794"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325909","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}
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