title: Mode of anaesthesia for preterm Caesarean delivery: secondary analysis from the Maternal-Fetal Medicine Units Network Caesarean Registry.
abstract: BACKGROUND
  Preterm delivery is often performed by Caesarean section. We investigated modes of anaesthesia and risk factors for general anaesthesia among women undergoing preterm Caesarean delivery.
  
  
  METHODS
  Women undergoing Caesarean delivery between 24(+0) and 36(+6) weeks' gestation were identified from a multicentre US registry. The mode of anaesthesia was classified as neuraxial anaesthesia (spinal, epidural, or combined spinal and epidural) or general anaesthesia. Logistic regression was used to identify patient characteristic, obstetric, and peripartum risk factors associated with general anaesthesia.
  
  
  RESULTS
  Within the study cohort, 11 539 women had preterm Caesarean delivery; 9510 (82.4%) underwent neuraxial anaesthesia and 2029 (17.6%) general anaesthesia. In our multivariate model, African-American race [adjusted odds ratio (aOR)=1.9; 95% confidence interval (CI)=1.7-2.2], Hispanic ethnicity (aOR=1.5; 95% CI=1.2-1.8), other race (aOR=1.4; 95% CI=1.1-1.9), and haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome or eclampsia (aOR=2.8; 95% CI=2.2-3.5) were independently associated with receiving general anaesthesia for preterm Caesarean delivery. Women with an emergency Caesarean delivery indication had the highest odds for general anaesthesia (aOR=3.5; 95% CI=3.1-3.9). For every 1 week decrease in gestational age at delivery, the adjusted odds of general anaesthesia increased by 13%.
  
  
  CONCLUSIONS
  In our study cohort, nearly one in five women received general anaesthesia for preterm Caesarean delivery. Although potential confounding by unmeasured factors cannot be excluded, our findings suggest that early gestational age at delivery, emergent Caesarean delivery indications, hypertensive disease, and non-Caucasian race or ethnicity are associated with general anaesthesia for preterm Caesarean delivery.
authors.affiliation: Department of Anaesthesia, Stanford University School of Medicine, Stanford, CA 94305, USA ajbut@stanford.edu.
authors.forename: A J
authors.initials: AJ
authors.lastname: Butwick
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Y Y
authors.initials: YY
authors.lastname: El-Sayed
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Y J
authors.initials: YJ
authors.lastname: Blumenfeld
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Osmundson
authors.affiliation: Department of Anaesthesia, Stanford University School of Medicine, Stanford, CA 94305, USA Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: C F
authors.initials: CF
authors.lastname: Weiniger
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical / Q000379:methods*; D002585:Cesarean Section / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D047928:Premature Birth; D011446:Prospective Studies; D012042:Registries
keywords: Caesarean; anaesthesia; preterm