Maternal deaths linked to regional anesthesia in childbirth increase

The number of women in the United States who die during childbirth from complications related to regional anesthesia, such as epidurals and spinal blocks, has risen gradually since the mid-1990s in contrast to an overall decline in anesthesia-related childbirth deaths during recent decades, a new study from the University of Colorado School of Medicine in Aurora finds. Reasons for the increase are unknown, although chronic conditions such as diabetes and hypertension increase risk of death during delivery.

Deaths related to regional anesthesia rose slightly, from 2.5 deaths per 1 million cesarean deliveries between 1991 and 1996 to 3.8 deaths per million between 1997 and 2002 (the latest year for which data are available), researchers found when they analyzed data from The Centers for Disease Control and Prevention’s Pregnancy Mortality Surveillance System. (Most anesthesia-related deaths reported between 1991 and 2002 involved cesarean delivery.) In contrast, deaths from general anesthesia decreased from 16.8 per million cesarean deliveries between 1991 and 1996 to 6.5 per million between 1997 and 2002. Deaths from any anesthesia complication fell 59% between 1979 and 2002, from 2.9 per million live births to 1.2 per million.

Although the upward trend in regional anesthesia-related deaths in childbirth is “concerning,” such deaths are rare, and women can minimize the risks, emphasizes lead author Joy L. Hawkins, MD. “I think the main thing is to get good prenatal care, and keep any medical conditions you have under control during pregnancy,” she says, adding that women should notify their anesthesiologist about their medical conditions and medications they’re taking.

Although the rarity of deaths related to regional anesthesia makes studying their causes difficult, Hawkins observes that information from malpractice claims points to a lack of emergency resuscitation equipment in the delivery room. Having such equipment at hand could make a difference, she suggests.

The study was published online December 20 in Obstetrics and Gynecology.