The MFMU cesarean registry: complications of anesthesia for cesarean delivery

Abstract

ObjectiveMost contemporary estimates of anesthesia-related maternal morbidity and mortality stem from death certificate data or retrospective chart reviews. The purpose of this analysis was to quantify anesthetic complications and associated maternal mortality in relation to method of anesthesia used in a large, well-described, prospectively ascertained cohort.Study designBetween 1 January 1999 and 31 December 2002, a prospective observational study of cesarean deliveries was conducted at 19 university centers. For this analysis information regarding the type of anesthesia, as well as associated complications, was abstracted from the maternal chart by specially trained research nurses.ResultsA total of 54,639 cesarean deliveries in women with singleton pregnancies were analyzed. Regional analgesia was the predominant method and accounted for 51,569 (94%) of the anesthetic procedures. General anesthesia was performed in 3070 (6%). The frequency of procedure-related complications is shown in the Table. There were 2 maternal deaths in which the anesthetic procedure could be directly implicated. One was associated with a failed intubation in a woman with a skeletal dysplasia. The other was associated with a posterior fossa subdural hematoma in an anticoagulated woman with a persistent spinal headache following continuous spinal anesthesia.ConclusionRegional anesthesia has virtually completely replaced general anesthesia for cesarean delivery. Procedure-related complications are rare and attest to the safety of modern obstetrical anesthesia for cesarean delivery. ObjectiveMost contemporary estimates of anesthesia-related maternal morbidity and mortality stem from death certificate data or retrospective chart reviews. The purpose of this analysis was to quantify anesthetic complications and associated maternal mortality in relation to method of anesthesia used in a large, well-described, prospectively ascertained cohort. Most contemporary estimates of anesthesia-related maternal morbidity and mortality stem from death certificate data or retrospective chart reviews. The purpose of this analysis was to quantify anesthetic complications and associated maternal mortality in relation to method of anesthesia used in a large, well-described, prospectively ascertained cohort. Study designBetween 1 January 1999 and 31 December 2002, a prospective observational study of cesarean deliveries was conducted at 19 university centers. For this analysis information regarding the type of anesthesia, as well as associated complications, was abstracted from the maternal chart by specially trained research nurses. Between 1 January 1999 and 31 December 2002, a prospective observational study of cesarean deliveries was conducted at 19 university centers. For this analysis information regarding the type of anesthesia, as well as associated complications, was abstracted from the maternal chart by specially trained research nurses. ResultsA total of 54,639 cesarean deliveries in women with singleton pregnancies were analyzed. Regional analgesia was the predominant method and accounted for 51,569 (94%) of the anesthetic procedures. General anesthesia was performed in 3070 (6%). The frequency of procedure-related complications is shown in the Table. There were 2 maternal deaths in which the anesthetic procedure could be directly implicated. One was associated with a failed intubation in a woman with a skeletal dysplasia. The other was associated with a posterior fossa subdural hematoma in an anticoagulated woman with a persistent spinal headache following continuous spinal anesthesia. A total of 54,639 cesarean deliveries in women with singleton pregnancies were analyzed. Regional analgesia was the predominant method and accounted for 51,569 (94%) of the anesthetic procedures. General anesthesia was performed in 3070 (6%). The frequency of procedure-related complications is shown in the Table. There were 2 maternal deaths in which the anesthetic procedure could be directly implicated. One was associated with a failed intubation in a woman with a skeletal dysplasia. The other was associated with a posterior fossa subdural hematoma in an anticoagulated woman with a persistent spinal headache following continuous spinal anesthesia. ConclusionRegional anesthesia has virtually completely replaced general anesthesia for cesarean delivery. Procedure-related complications are rare and attest to the safety of modern obstetrical anesthesia for cesarean delivery. Regional anesthesia has virtually completely replaced general anesthesia for cesarean delivery. Procedure-related complications are rare and attest to the safety of modern obstetrical anesthesia for cesarean delivery.