Method of Anesthesia and Perioperative Risk Factors, Maternal Anesthesia Complications, and Neonatal Mortality Following Cesarean Delivery in Africa: A Substudy of a 7-Day Prospective Observational Cohort Study
Authors' conclusion
Anesthesia complications and neonatal mortality were more frequent following GA. SA was often administered to high-risk patients, including those with eclampsia or obstetric hemorrhage.
Study context
- Population
- Patients undergoing cesarean delivery in 22 African countries (ASOS)3,709 analysed
- Participants
- 3,792 patients
- Comparison
- General anesthesia (GA) vs spinal anesthesia (SA) for cesarean delivery
- GAn = 741
- SAn = 2,968reference
- Primary endpoint
- Association between preoperative risk factors and method of anaesthesia delivered (GA)
Methodological detailsmulticentre, generalized linear mixed models
- Multicentre
- Generalized linear mixed models
Primary result
As reported in the abstract
Preoperative factors independently associated with GA
Adjusted odds ratio (95% CI)
Gestational age
1.093(1.052–1.135)
ASA III
11.84(2.93–46.31)
ASA IV
11.48(2.93–44.93)
Eclampsia
3.92(2.18–7.06)
Placental abruption
6.23(3.36–11.54)
Ruptured uterus
3.61(1.36–9.63)
Further findings
Neonatal mortality (unadjusted) · unadjusted
P < 0.001
Denominator SA 2669 · GA 662
SA use in high-risk subgroups
- Eclampsia: SA 48 of 94
- 51.1%
- Cardiac disease: SA 12 of 28
- 42.9%
- Preoperative sepsis: SA 14 of 19
- 73.7%
- Antepartum hemorrhage: SA 48 of 76
- 63.2%
- Placenta previa: SA 30 of 55
- 54.5%
- Placental abruption: SA 33 of 78
- 42.3%
- Ruptured uterus: SA 12 of 29
- 41.4%
Neonatal mortality (unadjusted)
- No association between method of anaesthesia and neonatal mortality in adjusted analysis
Intraoperative maternal hypotension
- No association with method of anaesthesia in adjusted analysis
Safety
All anaesthesia complications (composite maternal outcome)
P < 0.001
Denominator SA 2968 · GA 741
Original publication
Method of Anesthesia and Perioperative Risk Factors, Maternal Anesthesia Complications, and Neonatal Mortality Following Cesarean Delivery in Africa: A Substudy of a 7-Day Prospective Observational Cohort Study. Anesth Analg. Published 8 January 2024. doi:10.
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