Does obesity complicate regional anesthesia and result in longer decision to delivery time for emergency cesarean section?

Väänänen, Antti; Kainu, J.P.; Eriksson, H.; Lang, Michael; Tekay, Aydin; Sarvela, J.

doi:10.1111/aas.12891

Cited by 20 publications

(7 citation statements)

References 16 publications

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“…However there is the potential for neuraxial technical difficulty to occur in the face of clinical urgency. This may account for increased decision‐to‐delivery intervals that have recently been reported in obese women27 and supports the suggestion of inserting epidurals early, in laboring women who are obese.…”

Section: Discussionsupporting

confidence: 81%

Epidural extension failure in obese women is comparable to that of non‐obese women

Eley

Chin

Tham

et al. 2018

Acta Anaesthesiol Scand

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BackgroundManagement of labor epidurals in obese women is difficult and extension to surgical anesthesia is not always successful. Our previous retrospective pilot study found epidural extension was more likely to fail in obese women. This study used a prospective cohort to compare the failure rate of epidural extension in obese and non‐obese women and to identify risk factors for extension failure.MethodsOne hundred obese participants (Group O, body mass index ≥ 40 kg/m2) were prospectively identified and allocated two sequential controls (Group C, body mass index ≤ 30 kg/m2). All subjects utilized epidural labor analgesia and subsequently required anesthesia for cesarean section. The primary outcome measure was failure of the labor epidural to be used as the primary anesthetic technique. Risk factors for extension failure were identified using Chi‐squared and logistic regression.ResultsThe odds ratio (OR) of extension failure was 1.69 in Group O (20% vs. 13%; 95% CI: 0.88–3.21, P = 0.11). Risk factors for failure in obese women included ineffective labor analgesia requiring anesthesiologist intervention, (OR 3.94, 95% CI: 1.16–13.45, P = 0.028) and BMI > 50 kg/m2 (OR 3.42, 95% CI: 1.07–10.96, P = 0.038).ConclusionThe failure rate of epidural extension did not differ significantly between the groups. Further research is needed to determine the influence of body mass index > 50 kg/m2 on epidural extension for cesarean section.

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Section: Discussionsupporting

confidence: 81%

Epidural extension failure in obese women is comparable to that of non‐obese women

Eley

Chin

Tham

et al. 2018

Acta Anaesthesiol Scand

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“…Predictor variables were selected, based on a literature review5–9 11 13 16–21 (online supplemental table 1). We searched the MEDLINE database and Google Scholar for publications describing quality of care predictors for ECS using terms as ‘quality-of-care’, ‘Emergency-Caesarean-sections’, ‘decision-to-delivery’, ‘Anaesthesia’ and ‘Obesity’ 5–9 11 13 16–21. We hand searched references in key publications to help inform the content and selections of predictor variables in our study.…”

Section: Methodsmentioning

confidence: 99%

“…Protected by copyright. Open access maternal obesity 9 and whether the ECS was performed during the day or nighttime. 6 7 Additionally, communication skills between team members, 5 seniority of the surgeon 6 7 and midwifery staff level 8 have been found to correlate to quality of care.…”

Section: Introductionmentioning

confidence: 99%

“…To increase safety for the mother and the unborn child, monitoring the decision-to-delivery interval (DDI) has become an important part of obstetric audit 4. Key factors to reduce DDI suggested by prior studies include clinical urgency category,5–7 type of anaesthesia used,7 8 cervical dilatation,7 previous delivery by caesarean section,6 maternal obesity9 and whether the ECS was performed during the day or nighttime 6 7. Additionally, communication skills between team members,5 seniority of the surgeon6 7 and midwifery staff level8 have been found to correlate to quality of care.…”

Section: Introductionmentioning

confidence: 99%

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Using machine learning to identify quality-of-care predictors for emergency caesarean sections: a retrospective cohort study

et al. 2022

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ObjectivesEmergency caesarean sections (ECS) are time-sensitive procedures. Multiple factors may affect team efficiency but their relative importance remains unknown. This study aimed to identify the most important predictors contributing to quality of care during ECS in terms of the arrival-to-delivery interval.DesignA retrospective cohort study. ECS were classified by urgency using emergency categories one/two and three (delivery within 30 and 60 min). In total, 92 predictor variables were included in the analysis and grouped as follows: ‘Maternal objective’, ‘Maternal psychological’, ‘Fetal factors’, ‘ECS Indication’, ‘Emergency category’, ‘Type of anaesthesia’, ‘Team member qualifications and experience’ and ‘Procedural’. Data was analysed with a linear regression model using elastic net regularisation and jackknife technique to improve generalisability. The relative influence of the predictors, percentage significant predictor weight (PSPW) was calculated for each predictor to visualise the main determinants of arrival-to-delivery interval.Setting and participantsPatient records for mothers undergoing ECS between 2010 and 2017, Nordsjællands Hospital, Capital Region of Denmark.Primary outcome measuresArrival-to-delivery interval during ECS.ResultsData was obtained from 2409 patient records for women undergoing ECS. The group of predictors representing ‘Team member qualifications and experience’ was the most important predictor of arrival-to-delivery interval in all ECS emergency categories (PSPW 25.9% for ECS category one/two; PSPW 35.5% for ECS category three). In ECS category one/two the ‘Indication for ECS’ was the second most important predictor group (PSPW 24.9%). In ECS category three, the second most important predictor group was ‘Maternal objective predictors’ (PSPW 24.2%).ConclusionThis study provides empirical evidence for the importance of team member qualifications and experience relative to other predictors of arrival-to-delivery during ECS. Machine learning provides a promising method for expanding our current knowledge about the relative importance of different factors in predicting outcomes of complex obstetric events.

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“…In terms of cesarean delivery, a large body of evidence supports a positive association between pre-pregnancy BMI and cesarean delivery which makes women with higher BMI at a greater risk of delivery complications compared to those with lower BMI [3][4][5][6]. Also, women with higher BMI were found to have more time from decision till delivery and more epidural anesthesia failures compared to those with non-obese [7].…”

Section: Introductionmentioning

confidence: 99%

Association Between Maternal Obesity and Cesarean Delivery Complications

Saadia

2020

Cureus

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Background Several studies suggest that maternal obesity might be associated with intraoperative and postoperative complications of cesarean delivery. However, these results are not validated in the Pakistani population. Aim We aimed to assess the association between maternal obesity and intraoperative and postoperative complications of cesarean delivery. Methods We performed a retrospective observational study recording the prevalence of intraoperative and postoperative complications in women undergoing cesarean delivery. For all consecutive cesarean deliveries in Fehmida Sarfaraz hospital, Sialkot, Pakistan, we recorded the data of the maternal age, weight, body mass index (BMI), gestational age at delivery, intraoperative and postoperative complications, and the adverse pregnancy outcomes. We used the chi-square test, Spearman correlation, and linear regression to test the relationship between the study variables. Results We included 245 women in this study (non-obese group: n = 83; obese group: n = 162). BMI positively correlated with the incidence of deep venous thrombosis (DVT; r = 0.249), endometritis (r = 0.148), pyrexia (r=0.139), and wound infections (r = 0.155). Also, BMI could significantly predict DVT (Beta coefficient 2.886, P = 0.003), hospital stay (Beta coefficient 0.801, P = 0.001), pyrexia (Beta coefficient 0.819, P = 0.003), and wound infection (Beta coefficient 0.449, P = 0.049).

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Does obesity complicate regional anesthesia and result in longer decision to delivery time for emergency cesarean section?

Abstract: Higher BMI was associated with longer DDI and more regional anesthesia failures. Epidural top-up was faster than CSE for establishing CS anesthesia.

Cited by 20 publications

References 16 publications

Epidural extension failure in obese women is comparable to that of non‐obese women

Epidural extension failure in obese women is comparable to that of non‐obese women

Using machine learning to identify quality-of-care predictors for emergency caesarean sections: a retrospective cohort study

Association Between Maternal Obesity and Cesarean Delivery Complications

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