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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

Maternal BMI and other Factors Affecting the Success Rate of Labor Epidural Augmentation for Cesarean Delivery

Abstract Number: T2A-5
Abstract Type: Original Research

Tanmay Shah MD,MBBS1 ; Casey Windrix MD2

Introduction: Of all the conditions that can predict the likelihood of failure of labor epidural augmentation for cesarean delivery, we believe that patient’s BMI is a key factor that best predicts this failure. Early identification of labor epidural that may fail for cesarean delivery should prompt timely intervention and avoidance of an unplanned general anesthetic, which would improve the quality of care and decrease the morbidity and mortality for these parturient. Methods: We performed retrospective analysis of 1,625 patients’ medical records between 2011 and 2015 that received labor epidural analgesia (LEA) and required a non-emergent cesarean delivery at our institution. Data collected included maternal age, gestational age, and epidural placement attempts, number of rescue boluses; time to first rescue dose and manipulation of epidural catheter. A multivariate logistic regression model for each variable was performed and the odds ratio was calculated using SPSS software. It was considered the failure of labor epidural if any of these interventions were performed to provide supplemental analgesia during cesarean delivery in addition to augmentation of LEA. Those interventions were: general anesthesia, spinal anesthesia, inhalation analgesia with O2/N2O or intravenous ketamine administration. Results: 1,625 patients were screened and 1,591 patients were included in the analysis. When stratified according to BMI, the failure rate is shown to increase with increasing BMI, with the highest failure rate observed in patients with BMI>60. Number of epidural placement attempts, total number of rescue doses and time to first rescue dose after initiation of LEA were found to be elevated for a BMI>50 [Table 1]. The model correctly classified 73.6% of the cases, with a goodness of fit Hosmer & Lemeshow test p=0.123. Two factors were found to decrease the risk of conversion failure: increasing maternal age (OR=0.97, 95% CI 0.95-0.99) and increasing gestational age (OR=0.95, 95% CI 0.90-0.999). Increasing number of rescue doses (OR=1.21, 95% CI 1.11-1.32) was found to increase the risk. Conclusion: In conclusion, this study demonstrates that parturients with super obesity (BMI>50) are most likely at risk for failure of conversion of LEA to anesthesia for cesarean delivery in addition to other factors including increased number of placement attempts, increased number of rescue doses, catheter manipulation and decreased time to first rescue dose.

SOAP 2018