Serious complications from anesthesia very rare during childbirth, new study finds

Expectant mothers concerned about receiving an epidural, spinal or general anesthesia during childbirth can breathe a little easier.  According to a study published in the June issue of Anesthesiology, the official medical journal of the American Society of Anesthesiologists® (ASA®), serious complications due to anesthesia during childbirth are very rare, occurring in one out of every 3,000 deliveries.

“This is the first multicenter study to examine the incidence of serious complications associated with obstetric anesthesia,” said Robert D’Angelo, M.D., study lead author, department of anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.  “We were extremely pleased to find that serious complications such as bleeding, infection, paralysis and maternal death were extremely rare.  However, since many complications can lead to catastrophic outcomes, it is important that physician anesthesiologists remain vigilant and prepared to rapidly diagnose and treat any complication, should it arise.”

Using data from the Society for Obstetric Anesthesia and Perinatology’s (SOAP’s) Serious Complication Repository (SCORE) project – a large, comprehensive database that systematically captures delivery statistics and tracks complications – the authors identified more than 257,000 deliveries (including both vaginal and cesarean) where epidural, spinal or general anesthesia was administered during childbirth.  Thirty institutions participated in the five-year study between 2004 and 2009. 

There were 157 total complications reported, 85 of which were anesthesia-related.  Although complications were rare, the most frequent anesthesia-related complications were high neuraxial block, an unexpected high level of anesthesia developing in the central nervous system, (one in 4,336 deliveries); respiratory arrest in labor and delivery (one in 10,042); and unrecognized spinal catheter, an undetected infusion of local anesthetic through an accidental puncture of one of three outer spinal cord membranes, (one in 15,435). 

In an effort to reduce the incidence of complications and improve patient safety, a secondary goal of the study was to identify risk factors associated with each complication to produce formal practice advisories or guideline recommendations.  However, because serious complications related to obstetric anesthesia are so rare, there were too few complications in each category to identify risk factors associated with each complication.  Still, the authors note that the findings from the study can be used to guide informed consent discussions with patients. 

Findings from the study will also be used to establish a national obstetric anesthesia complication registry as part of the Anesthesia Incident Reporting System developed by ASA’s Anesthesia Quality Institute (AQI) in collaboration with the leaders of SOAP.  Unique adverse events captured by this system will be used to generate new alerts to anesthesiologists and new educational materials to advance patient safety.