This follow-up paper to Hawkin's original "Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990" showed a dramatic improvement in the relative risk of cesarean section death with general vs regional anesthesia compared with the original 1979-1990.

Where previously (1979-1990) the relative risk of death during GA CS was 16.7, from 1997-2002 the relative risk had fallen to 1.7. Worryingly though this was both due to a falling mortality rate for GA CS and an increasing mortality rate for regional anesthesia CS.

Cesarean section under general anesthesia still exposes mothers to an increased risk of perioperative death, but this risk is much lower than previously, likely due to better anesthesia training, supervision and respect of the obstetric airway.

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• Joy L Hawkins, Jeani Chang, Susan K Palmer, Charles P Gibbs, and William M Callaghan.
• Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado 80045, USA. Joy.Hawkins@ucdenver.edu
• Obstet Gynecol. 2011 Jan 1;117(1):69-74.

ObjectiveTo examine 12 years of anesthesia-related maternal deaths from 1991 to 2002 and compare them with data from 1979 to 1990, to estimate trends in anesthesia-related maternal mortality over time, and to compare the risks of general and regional anesthesia during cesarean delivery.MethodsThe authors reviewed anesthesia-related maternal deaths that occurred from 1991 to 2002. Type of anesthesia involved, mode of delivery, and cause of death were determined. Pregnancy-related mortality ratios, defined as pregnancy-related deaths due to anesthesia per million live births were calculated. Case fatality rates were estimated by applying a national estimate of the proportion of regional and general anesthetics to the national cesarean delivery rate.ResultsEighty-six pregnancy-related deaths were associated with complications of anesthesia, or 1.6% of total pregnancy-related deaths. Pregnancy-related mortality ratios for deaths related to anesthesia is 1.2 per million live births for 1991-2002, a decrease of 59% from 1979-1990. Deaths mostly occurred among younger women, but the percentage of deaths among women aged 35-39 years increased substantially. Delivery method could not be determined in 14%, but the remaining 86% were undergoing cesarean delivery. Case-fatality rates for general anesthesia were 16.8 per million in 1991-1996 and 6.5 per million in 1997-2002, and for regional anesthesia were 2.5 and 3.8 per million, respectively. The resulting risk ratio between the two techniques for 1997-2002 was 1.7 (confidence interval 0.6-4.6, P=.2).ConclusionAnesthetic-related maternal mortality decreased nearly 60% when data from 1979-1990 were compared with data from 1991-2002. Although case-fatality rates for general anesthesia are falling, rates for regional anesthesia are rising.Level Of EvidenceII.

This article appears in the collection: Landmark obstetric anesthesia papers.

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