Anaesthesia for caesarean delivery in women with class 3 obesity: a retrospective cohort study from the north-west of England (2022–2023)

Bhatia, K; Columb, M; Roberts, B; Turner, K; Coffey, E; Moxon, H; Baker, M; Pollington, C; Lie, J; Dixon, S; Musselbrook, W; Hulgur, M; Markey, T; Kumari, S; Burrow, M; Sashankar, A; Group of Obstetric Anesthetists of Lancashire, Greater Manchester, Mersey GOAL-GM Study Collaborators

doi:10.1016/j.ijoa.2025.104343

Obstetric anesthesia

Anaesthesia for caesarean delivery in women with class 3 obesity: a retrospective cohort study from the north-west of England (2022–2023)

Int J Obstet AnesthPublished 13 Feb 2025Retrospective cohort study

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Authors' conclusion

As BMI increases, anaesthetists tend to favour a CSE technique over spinal anaesthesia. Maternity units found it challenging to comply with the specified RCOA/RCOG standards.

Study context

Population: Women with body mass index (BMI) ≥40 kg/m² undergoing caesarean delivery (CD) across nine maternity units in the north-west of England9 maternity units
Participants: 760 women

Exposure: Anaesthetic technique across BMI cohorts
Outcome: Variation in anaesthetic technique across BMI cohorts

Methodological detailsmulticentre (nine maternity units)

Multicentre (nine maternity units)

Main finding

As reported in the abstract

Anaesthetic technique by BMI cohort

≥40-49.99 kg/m²81.1%

≥50-59.99 kg/m²67.2%

≥60 kg/m²45.5%

CSE use

≥40-49.99 kg/m²4%

≥50-59.99 kg/m²19.4%

≥60 kg/m²45.5%

Spinal anaesthesia rate across BMI cohorts: P = 0.0001 — value = spinal anaesthesia rate
Combined spinal epidural (CSE) use across BMI cohorts: P < 0.0001

Neuraxial anaesthesia successfully utilised (overall): 92.6%
Primary general anaesthesia (GA) (overall), no difference across BMI cohorts: 3.7%
Neuraxial to GA conversion (overall), no difference across BMI cohorts: 3.8%

Observational data: associations, not effects.

Further findings

Adherence with Royal College of Anaesthetists (RCOA)/Royal College of Obstetricians and Gynaecologists (RCOG) standards

Hospitals meeting neuraxial anaesthesia standards for all CD categories: at least 66.7%
Hospitals meeting neuraxial to GA conversion standards for elective CD: 33.3%
Re-weighed in third trimester: 24.9%
Anaesthetic clinic attendance recorded: 57%
Anaesthesia provided by ST6 or above: 87.1%

Safety

Documented pain during CD (PDCD)

PDCD documented: 6.1%

Original publication

Anaesthesia for caesarean delivery in women with class 3 obesity: a retrospective cohort study from the north-west of England (2022–2023). Int J Obstet Anesth. Published 13 February 2025. doi:10.1016/j.ijoa.2025.104343

Read the original article ↗

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