title: Complications of anesthesia for cesarean delivery.
abstract: OBJECTIVE
  To quantify anesthesia-related complications associated with cesarean delivery in a well-described, prospectively ascertained cohort from multiple university-based hospitals in the United States and to evaluate whether certain factors would identify women at increased risk for a failed regional anesthetic.
  
  
  METHODS
  A prospective observational study was conducted of women (n = 37,142) with singleton gestations undergoing cesarean delivery in the centers forming the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Detailed information was collected regarding choice of anesthesia and procedure-related complications, including failed regional anesthetic and maternal death. Potential risk factors for a failed regional anesthetic were analyzed.
  
  
  RESULTS
  Of the women studied, 34,615 (93%) received a regional anesthetic. Few (3.0%) regional procedures failed, and related maternal morbidity was rare. Increased maternal size, higher preoperative risk, rapid decision-to-incision interval, and placement later in labor were all significantly related to an increased risk of a failed regional procedure. Of the general anesthetics, 38% were administered when the decision-to-incision interval was less than 15 minutes. Women deemed at the greatest preoperative risk (American Society of Anesthesiologists score > or = 4) were approximately 7-fold more likely to receive a general anesthetic (odds ratio 6.9, 95% confidence interval 5.83-8.07). There was one maternal death, due to a failed intubation, in which the anesthetic procedure was directly implicated.
  
  
  CONCLUSIONS
  Regional techniques have become the preferred method of anesthesia for cesarean delivery. Procedure-related complications are rare and attest to the safety of modern obstetric anesthesia for cesarean delivery in the United States.
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9032, USA. steven.bloom@utsouthwestern.edu
authors.forename: Steven L
authors.initials: SL
authors.lastname: Bloom
authors.forename: Catherine Y
authors.initials: CY
authors.lastname: Spong
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Weiner
authors.forename: Mark B
authors.initials: MB
authors.lastname: Landon
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
authors.forename: Michael W
authors.initials: MW
authors.lastname: Varner
authors.forename: Atef H
authors.initials: AH
authors.lastname: Moawad
authors.forename: Steve N
authors.initials: SN
authors.lastname: Caritis
authors.forename: Margaret
authors.initials: M
authors.lastname: Harper
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wapner
authors.forename: Yoram
authors.initials: Y
authors.lastname: Sorokin
authors.forename: Menachem
authors.initials: M
authors.lastname: Miodovnik
authors.forename: Mary J
authors.initials: MJ
authors.lastname: O'Sullivan
authors.forename: Baha
authors.initials: B
authors.lastname: Sibai
authors.forename: Oded
authors.initials: O
authors.lastname: Langer
authors.forename: Steven G
authors.initials: SG
authors.lastname: Gabbe
mesh_terms: D000293:Adolescent; D000328:Adult; D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000401:mortality; D000768:Anesthesia, General / Q000009:adverse effects; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D002585:Cesarean Section; D002648:Child; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies