Expectant mothers are often concerned about the safety of getting an epidural or spinal anesthesia for relieving the pain of childbirth; the findings of a new study from hospitals in New York could put their minds at ease. Researchers have observed that the rate of post-anesthesia complications have significantly decreased – up to 25 percent over the last ten years – in women who received spinal anesthesia or an epidural for C-section delivery.
The main conclusion of the study: epidural or spinal anesthesia is generally preferred for cesarean deliveries, but in certain cases, general anesthesia can be administered, such as during an emergency C-section.
Anesthesia During A Caesarean Section
Lead author of the study Jean Guglielminotti, M.D., Ph.D., Postdoctoral Research Fellow in the Department of Anesthesiology, Columbia University Medical Center, New York highlighted that caesarean section (C-section) delivery was the most routinely performed impatient surgical procedure in the US. Among these surgeries, 1.3 million are performed under spinal, epidural, or general anesthesia.
Women who give birth via C-section generally have an increased risk of suffering from post-anesthesia complications as compared to those who deliver vaginally. However, the present study demonstrates that the statistics for anesthesia related outcomes in C-section deliveries have improved significantly.
Examining Complications And Gathering Data
Dr. Guglielminotti, along with co-authors Guohua Li, M.D., Dr PH, Ruth Landau, M.D., at Columbia University Medical Center and Cynthia A. Wong, M.D., at Northwestern University Feinberg School of Medicine, Chicago analyzed the trends in major and minor anesthesia-related complications, such as cardiac arrest and death, and headache, backaches and emotional discomfort respectively. Certain perioperative complications, including heart failure, stroke, acute respiratory failure which were unrelated to anesthesia were also examined.
Moreover, researchers also observed the overall mortality rates in 785,854 cesarean deliveries performed in New York state hospitals between 2003 and 2012. Other factors that were assessed included maternal age, type of anesthesia and outcome features.
Evaluating Statistics And Making Inferences
Out of all the 785,854 cesarean deliveries examined, 5,715 developed at least one anesthesia-related complication. Overall, the rate of major and minor anesthesia-related complications in patients having received an epidural or spinal anesthesia during cesarean delivery was observed to decrease by 25 percent – 8.9 per 1,000 C-sections in 2003 to 6.6 per 1,000 C-sections in 2012.
However, no decrease in anesthesia-related complications was observed in C-sections performed under general anesthesia.
In comparison, the rate of perioperative complications apart from anesthesia were seen to increase by 47 percent over the last ten years; at least one such complication was reported in 7,040 cesarean deliveries. According to researchers, this could be because majority of the women might have serious preexisting medical complications.
Overall, the number of C-sections being performed increased had increased from 29 percent in 2003 to 35 percent in 2012, with a large proportion of women above the age of 40 with preexisting medical conditions.
Bottom line: on the whole, in-hospital mortality rates after a cesarean delivery significantly decreased.
Conclusions Of The Study
“Over the last 20 years, providers of obstetric anesthesia have focused primarily on improving the safety and quality of care given to expectant mothers during pain relief regimes in labor and while administering anesthesia for cesarean delivery”, explained Dr. Guglielminotti. “Our findings highlight the significance and success of intervention programs in improving obstetric anesthesia care. This is even more important due to the high cesarean delivery rate in the US, along with the increase in maternal age, chronic diseases and number of high-risk pregnancies”.
Physician anesthesiologists uphold an excellent safety record for dealing with anesthesia-related complications. However, obstetricians and others must work to further minimize the complications by contributing as ‘peri-delivery’ physicians. The study was published in Anesthesiology, the official medical journal of the American Society of Anesthesiologists (ASA).