Key result
Elevated maternal BMI (>35) was associated with longer decision-to-delivery intervals and higher rates of regional anesthesia failure (8.5% vs 3.7% for BMI <30; P=0.021) in emergency CS.
Why the study?
Does elevated maternal BMI increase decision-to-delivery interval and regional anesthesia failure in emergency cesarean sections?
Observational (n=842)
No
Does elevated maternal BMI increase decision-to-delivery interval and regional anesthesia failure in emergency cesarean sections?
Absolute Event Rate: 8.5% vs 3.7%
p-value: p=0.021
Higher maternal BMI is associated with longer decision-to-delivery intervals and increased rates of regional anesthesia failure during emergency cesarean sections.
May warrant heightened preparedness for delays and anesthesia failure in high-BMI emergency CS; leaves open need for prospective validation before practice change.
BACKGROUND: Maternal obesity can cause problems with anesthesia and surgery which may be reflected in emergency cesarean sections (CS) as an increased decision-to-delivery interval (DDI). AIM: To study the association of elevated maternal BMI with DDI and the failure of regional anesthesia. METHODS: Eight hundred and forty-two consecutive emergency CSs during a period of 1 year in a tertiary hospital were studied retrospectively. DDIs were analyzed in Crash and < 30-min urgency categories (n = 528), while the time required to establish regional anesthesia and its success were analyzed for all emergency CS cases. RESULTS: The urgency distribution of the CSs was 11%, 52%, and 37% in Crash, < 30-min, and > 30-min urgency categories respectively. Increased BMI was associated with longer DDI time in the < 30-min urgency category (33(13-176) vs. 38(18-118) min; P < 0.05 for BMI < 30 and > 35 group respectively). Regional anesthesia failures (new regional anesthesia, conversion to general anesthesia, or complaint of pain during surgery) took place in 3.7%, 6.8%, and 8.5% in the BMI < 30, 30-35, and > 35 groups respectively (P = 0.021). Epidural top-up resulted in shorter DDI and time delay between arrival at the operating room and skin incision across all urgency and BMI groups than combined spinal epidural (CSE) anesthesia. CONCLUSION: Higher BMI was associated with longer DDI and more regional anesthesia failures. Epidural top-up was faster than CSE for establishing CS anesthesia.
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Väänänen et al. (2017) conducted an observational in Emergency cesarean section (n=842). Elevated maternal BMI (>35) vs. BMI < 30 was evaluated on Regional anesthesia failure (p=0.021). Elevated maternal BMI (>35) was associated with longer decision-to-delivery intervals and higher rates of regional anesthesia failure (8.5% vs 3.7% for BMI <30; P=0.021) in emergency CS.
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