Biel Frances M, Marshall Nicole E, Snowden Jonathan M
Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
Oregon Health and Science-University-Portland State University School of Public Health, Portland, OR.
Paediatr Perinat Epidemiol. 2017 Nov;31(6):495-505. doi: 10.1111/ppe.12387. Epub 2017 Aug 22.
There is an evidence gap regarding the use of regional anaesthesia (epidural, spinal, or combined epidural/spinal anaesthesia) and associated complications by maternal body mass index (BMI). We examine associations between regional anaesthesia, mode of delivery, and regional anaesthesia complications by pre-pregnancy BMI categories among term deliveries.
Retrospective cohort study of births in California, 2007-2010, utilizing linked birth certificate data and patient discharge data. Outcomes were mode of delivery (among laboured deliveries) and select regional anaesthesia complications. Multivariable Poisson regression was used to adjust for maternal characteristics.
In women undergoing labour (i.e. laboured delivery), women with higher BMI categories were more likely to receive regional analgesia in a dose-response fashion (adjusted risk ratio [RR] 1.10, 95% confidence interval [CI] 1.10, 1.11 for primiparous women with category I obesity), and in those receiving regional anaesthesia, were less likely to deliver vaginally (e.g. RR 0.85, 95% CI 0.84, 0.85 for the same category of women). Regional anaesthesia complications displayed a complex relationship with maternal BMI, with women in intermediate obesity categories having decreased odds as compared to normal-weight women, and women in the highest BMI category having a twofold increased risk of complications (RR 2.34, 95% CI 1.37, 4.02 for primiparous women).
Labouring women in higher BMI categories were more likely to receive regional anaesthesia and more likely to deliver via caesarean compared to normal weight women and women without regional anaesthesia. Rates of anaesthesia complications were highest among women in the highest BMI category.
关于按产妇体重指数（BMI）使用区域麻醉（硬膜外麻醉、脊髓麻醉或联合硬膜外/脊髓麻醉）及其相关并发症，存在证据空白。我们研究了足月分娩中按孕前BMI类别划分的区域麻醉、分娩方式和区域麻醉并发症之间的关联。
利用加利福尼亚州2007 - 2010年出生记录的回顾性队列研究，将出生证明数据与患者出院数据相链接。结局指标为分娩方式（在经阴道分娩中）和特定区域麻醉并发症。采用多变量泊松回归对产妇特征进行校正。
在经历分娩（即经阴道分娩）的女性中，BMI类别较高的女性更有可能以剂量反应方式接受区域镇痛（对于I级肥胖的初产妇，校正风险比[RR]为1.10，95%置信区间[CI]为1.10，1.11），并且在接受区域麻醉的女性中，阴道分娩的可能性较小（例如，同一类别的女性RR为0.85，95% CI为0.84，0.85）。区域麻醉并发症与产妇BMI呈现复杂关系，中度肥胖类别的女性与正常体重女性相比并发症几率降低，而BMI最高类别的女性并发症风险增加两倍（初产妇的RR为2.34，95% CI为1.37，4.02）。
与正常体重女性和未接受区域麻醉的女性相比，BMI类别较高的分娩女性更有可能接受区域麻醉，且更有可能通过剖宫产分娩。BMI最高类别的女性麻醉并发症发生率最高。
