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P301 How spinal anaesthesia has revolutionised the practice of caesarean section from a post-mortem procedure to a popularised and life-saving procedure in the 21st century
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P301 How spinal anaesthesia has revolutionised the practice of caesarean section from a post-mortem procedure to a popularised and life-saving procedure in the 21st century
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Journal Article
P301 How spinal anaesthesia has revolutionised the practice of caesarean section from a post-mortem procedure to a popularised and life-saving procedure in the 21st century
2025
Overview
Application for ESRA Abstract Prizes:Background and AimsIn the 1800s, in Sweden and France, countries with the best maternal health today, nearly 1 in 100 women died from childbirth. Major causes included haemorrhage and sepsis. Traditionally, caesaren section was a post-mortem practice. Today, in many developed countries, it represents the commonest major abdominal surgery in young adults.MethodsHistorically, general anaesthesia was primarily used for caesareans. However, concerning reports of anaesthesia-related complications emerged in 1951, mainly pulmonary aspiration, difficult intubations and hypoxic injury. In 1764, Magendie described the presence of nerves surrounded by fluid circulating around the brain and spinal cord, contributing to pain and movement. In 1898, Bier described total lower body numbness following intrathecal injection of cocaine. Development of pencil-point needle tips limiting post-spinal headaches and ability to remain conscious led to improved maternal satisfaction and acceptance with spinal anaesthesia.ResultsGeneral anaesthesia has been superseded by spinal anaesthesia, accounting for only 6% of caesareans in 2011, versus 35% in 1980. The safer provision of anaesthesia during caesarean has given rise to its soaring incidence worldwide. Whilst maternal and healthcare professional attitudes have contributed in the elective setting, medical indications remain significant, including life-threatening maternal and foetal conditions, allowing millions of women and babies to survive childbirth.ConclusionsToday, maternal mortality rates are lowest (3–4 per 100,000) in developed countries. High mortality rates remain in countries with poor access to anaesthesia providers and operative facilities. While spinal anaesthesia has permitted safer caesareans, future efforts need to be made to improve the availability of obstetrics anaesthesia in developing countries.
Publisher
BMJ Publishing Group LTD
Subject
