Obstetric anaesthesia for caesarean section in Central Europe: a prospective population-weighted binational audit (OBAAMA-COV Study).

BACKGROUND

Neuraxial anaesthesia is recommended as the preferred technique for caesarean section, and the proportion performed under general anaesthesia is increasingly regarded as a quality indicator. Previous national audits in the Czech Republic and Slovakia demonstrated a reduction in general anaesthesia rates between 2011 and 2015; however, contemporary population-level data are lacking.

METHODS

OBAAMA-COV was a prospective, cross-sectional national audit conducted in November 2022 across maternity units in the Czech Republic and Slovakia. Consecutive caesarean sections were recorded using a structured electronic registry. Population weighting based on official national statistics was applied to generate representative estimates of anaesthetic technique distributions and reported indications. The analyses were descriptive.

RESULTS

A total of 2,270 caesarean sections were recorded from 94 centres. Population-weighted estimates corresponded to 2,068 procedures in the Czech Republic and 1,205 in Slovakia. Overall general anaesthesia rates were 33.9% and 31.3%, respectively. In elective procedures, general anaesthesia was used in 23.0% (95% CI 19.9-26.4) in the Czech Republic and 24.9% (20.6-29.7) in Slovakia; in emergency procedures, rates were 45.4% (42.1-48.8) and 36.8% (31.8-42.1), respectively. Maternal preference was the leading reported indication in elective cases (approximately 60-63% across audit cycles), whereas urgency predominated in emergency settings. Rapid sequence induction with tracheal intubation was used in most cases; difficult intubation occurred in approximately 2% of cases, and no aspiration was recorded. Umbilical arterial pH values were comparable between general anaesthesia and neuraxial techniques.

CONCLUSIONS

These population-weighted data demonstrate a persistent divergence from contemporary European standards. General anaesthesia for caesarean section remains common in both countries, plateauing rather than declining since 2015. The continued reliance on general anaesthesia-driven by maternal preference in elective procedures and by urgency in acute settings-suggests an important contribution of organisational and sociocultural factors beyond strictly clinical indications.

TRIAL REGISTRATION: ClinicalTrials.gov (NCT04912791), registered June 2, 2021.