title: Maternal and fetal outcomes following unplanned conversion to general anesthetic at elective cesarean section.
abstract: OBJECTIVE
  To investigate risk factors predicting unplanned conversion to general anesthesia during elective cesarean section, and to examine maternal and fetal outcomes associated with unplanned conversion compared with other modes of anesthesia.
  
  
  METHODS
  A retrospective cohort at a UK center (2008 to 2013). Women (4337) underwent elective cesarean section. Delivery outcomes were compared according to anesthesia type using logistic regression.
  
  
  RESULTS
  Women (1.6%) underwent unplanned conversion to general anesthetic. Unplanned conversion was associated with higher parity (odds ratio (OR) 3.82, confidence interval (CI; (1.58 to 9.62)) and maternal age ⩾40 (OR 4.40, CI (1.08 to 29.88)). Compared with spinal anesthetic, unplanned conversion was associated with increased likelihood of maternal hemorrhage ⩾1.5 l (OR 5.74, CI (1.90 to 14.01)) and delayed neonatal respiration (OR 4.76, CI (1.76 to 11.05)). Adverse outcomes were not significantly more likely compared with planned general anesthetic.
  
  
  CONCLUSIONS
  Higher parity and maternal age are risk factors for unplanned conversion to general anesthetic. There is no increase in the likelihood of adverse outcomes with unplanned versus planned general anesthetic.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Cambridge, Addenbrooke's Hospital, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK.
authors.forename: C E
authors.initials: CE
authors.lastname: Aiken
authors.affiliation: Office of Population Research, Wallace Hall, Princeton University, Princeton, NJ, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Aiken
authors.affiliation: Department of Obstetrics and Gynaecology, University of Cambridge, Addenbrooke's Hospital, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK.
authors.forename: J C
authors.initials: JC
authors.lastname: Cole
authors.affiliation: Department of Obstetrics and Gynaecology, University of Cambridge, Addenbrooke's Hospital, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK.
authors.forename: J C
authors.initials: JC
authors.lastname: Brockelsby
authors.affiliation: Department of Anaesthesia, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: J H
authors.initials: JH
authors.lastname: Bamber
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000379:methods / Q000706:statistics & numerical data; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008423:Maternal Age; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D010298:Parity; D010347:Patient Care Planning / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome; D006113:United Kingdom / Q000453:epidemiology