Epidural Anesthesia Safe for Cesarean Delivery

A new study finds that the rate of anesthesia-related complications in women who received epidural or spinal anesthesia for cesarean delivery (CD) decreased by 25% over the past decade.

Researchers at Columbia University Medical Center (New York, NY, USA), Hôpital Bichat-Claude Bernard (Paris, France), and other institutions examined trends in anesthesia-related complications, perioperative complications unrelated to anesthesia--such as acute heart failure, acute respiratory failure, stroke--and overall mortality in 785,854 CDs in New York state hospitals between 2003 and 2012. Patients' maternal age, type of anesthesia, and outcome characteristics were reviewed.

The results showed that the overall rate of major and minor anesthesia-related complications for those who received spinal or epidural anesthesia during CD decreased from 8.9 per 1,000 in 2003 to 6.6 per 1,000 in 2012. No decrease in complications was observed, however, in CDs performed under general anesthesia. In contrast, the rate of perioperative complications unrelated to anesthesia increased 47% over the last decade, with at least one non-anesthetic perioperative complication occurring in 7,040 CDs.

The authors observed the number of cesarean deliveries performed significantly increased during the same time, from 29% in 2003 to 35% in 2012, with the proportion of women over age 40 having cesareans also increasing, as well as in women with preexisting medical conditions. Nonetheless, the overall in-hospital mortality rate after CD significantly decreased. The study was published in the September 2015 online first edition of Anesthesiology.

“Cesarean delivery is the most commonly performed inpatient-surgical procedure in the United States, with 1.3 million cesareans being performed under epidural, spinal, or general anesthesia each year,” said lead author Jean Guglielminotti, MD, PhD. “Women giving birth by cesarean delivery are generally at an increased risk for experiencing complications from anesthesia compared to women who deliver vaginally. However, our research shows anesthesia-related outcomes in cesarean deliveries have significantly improved.”

“Over the last two decades, obstetric anesthesia providers have focused on improving the quality and safety of care provided to expectant mothers while providing pain relief during labor and safe anesthesia for cesarean delivery,” concluded Dr. Guglielminotti. “Our research highlights the importance and success of intervention programs to improve obstetric anesthesia care. This is all the more important with the high cesarean delivery rate in the US and the increase in maternal age, chronic maternal diseases and high-risk pregnancies.”

Related Links:
Columbia University Medical Center
Hôpital Bichat-Claude Bernard