Obstetrical anesthesia: new data on the risks

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Virtually all Los Angeles hospitals offer epidural anesthesia to patients in labor. It allows a remarkable degree of comfort from labor pains ...; unfortunately, it is not without risk. In many cases, anesthesia is optional; however, it is a necessity for a cesarean delivery. A new study ... reviewed 12 years of obstetrical anesthesia-related deaths ... The authors reported 86 deaths that were associated with complications of anesthesia; these deaths represented 1.6% of total pregnancy-related deaths. Pregnancy-related mortality ratios for deaths related to anesthesia was 1.2 per million live births for 1991–2002, which was a decrease of 59% from 1979–1990. Deaths mostly occurred among younger women; however, the percentage of deaths among women aged 35–39 years of age increased significantly. The delivery method could not be determined in 14% of the cases; however, the remaining 86% were in women undergoing a cesarean delivery. Case-fatality rates for general anesthesia were 16.8 per million in 1991–1996 and 6.5 per million in 1997–2002; for regional (epidural or spinal) anesthesia, they were 2.5 per million in 1991–1996 and 3.8 per million in 1997–2002.

Overall, the leading causes of anesthesia-related pregnancy deaths for 1991–2002 were: intubation, ... failure or induction (starting general anesthesia) problems (23%); respiratory failure (20%), and high spinal or epidural block (16%) ... The causes varied by the type of obstetric anesthesia administered. About two-thirds of deaths associated with general anesthesia were caused by intubation failure or induction problems; however, for women whose deaths were associated with regional anesthesia during cesarean delivery, (26%) were caused by high spinal or epidural block, followed by respiratory failure (19%), and drug reaction.

The authors concluded:

* Anesthetic-related maternal mortality decreased nearly 60% when data from 1979–1990 were compared with data from 1991–2002. * Although case-fatality rates for general anesthesia are decreasing, rates for regional anesthesia are rising.

Melissa Maimann, Essential Birth Consulting 0400 418 448