( Anesthesiology 2025 Oct 1;143(4):827–834. doi: 10.1097/ALN.0000000000005634) An important current issue in pediatric anesthesiology is the possible neurotoxic effects of anesthetic agents in early childhood; studies have demonstrated that exposure to these agents during critical brain development periods can cause nerve cell damage, disrupt brain connectivity, and lead to lasting issues with memory and learning. Though many studies on this topic have been published, the true effects of these agents are still largely unknown, necessitating further research. This study was designed to assess intelligence and behavioral assessment outcomes between sevoflurane alone and dexmedetomidine and remifentanil combined with sevoflurane during a single exposure.
( Anesth Analg 2026 Apr 1;142(4):653–663. doi: 10.1213/ANE.0000000000007718) A retrospective cohort study examined outcomes among patients undergoing major noncardiac surgery within a German hospital network, comparing 3 distinct care approaches: transfusion-free blood management (TFBM) for nontransfusable patients, patient blood management (PBM) for transfusable patients, and standard care without PBM. The primary goal was to evaluate differences between nontransfusable and transfusable patients, while the secondary objective was to compare PBM with no-PBM in transfusable individuals.
( Int J Obstet Anesth 2025 Aug:63:104693. doi:10.1016/j.ijoa.2025.104693) This prospective qualitative study explored how mothers experience a category 1 cesarean delivery (CD) performed under general anesthesia (GA) when their partner is present in the operating room. Category 1 CDs are conducted in situations involving an immediate threat to the life of the mother and/or infant and must meet a rapid decision-to-delivery interval of no more than 15 minutes in Denmark. To achieve this timeframe, GA is routinely used. Traditionally, partners were excluded from the operating room; however, since 2021, the study hospital has allowed partners to remain with the mother throughout the entire procedure. While prior research showed that partners strongly preferred being present, little was known about how mothers experienced this practice.
( Obstet Gynecol . 2026 Apr 1;147(4):479–490. doi: 10.1097/AOG.0000000000006084) The life expectancy of individuals with cystic fibrosis (CF) has increased drastically in the last few decades, meaning more individuals with CF are able to have children. Overall health in CF has also improved, meaning pregnancy has become more achievable and common. This is a direct reflection of the CF transmembrane conductance regulator (CFTR) therapy. This article is a review discussing considerations for reproductive health and the use of CF therapeutics in these patients during pregnancy in this population. It includes an overview of CF, genetics and inheritance involved in the condition, novel therapies, fertility, counseling, and the management of CF before and during pregnancy, as well as potential effects on developing fetuses and ongoing areas of research.
( Am J Obstet Gynecol 2025;233:297.e1–e12. doi: 10.1016/j.ajog.2025.03.021) The placement of an intrauterine device (IUD) is a safe, common, and reliable procedure for contraception; fear of pain during the procedure is often a deterrent for patients who would otherwise choose an IUD, particularly for patients who are nulliparous. Recent media such as press coverage and social media have emphasized painful, negative, and some traumatic experiences during IUD placement, and many patients are advocating for better options for pain management and support from clinicians during the procedure. Many pain relief regimens have been proposed and there is a lack of consistent evidence as to which are the safest and most effective regimens, and if these differ between nulliparous and multiparous women. This study was designed to evaluate differences in pain medication regimens in a statewide health system in nulliparous patients, with emphasis on identifying patient and clinician factors influencing differences in receiving medication before or during IUD placement.
( Int J Obstet Anesth 2025 Aug:63:104704. doi: 10.1016/j.ijoa.2025.104704) Postpartum hemorrhage (PPH) remains a leading contributor to maternal deaths worldwide, particularly in low-resource regions, with uterine atony responsible for most cases. Because calcium (Ca) ions are central to myometrial contractility, low Ca levels have been linked to poor uterine tone and increased risk of PPH. Although small studies have evaluated intravenous (IV) calcium as a preventive measure, the evidence has been inconsistent. This randomized, placebo-controlled trial sought to determine whether administering prophylactic IV calcium gluconate (CaGlu) during intrapartum cesarean delivery (CD) under spinal anesthesia would improve uterine tone and reduce markers of uterine atony.
( BMJ 2025; 391:e085710. doi:10.1136/bmj-2025-085710) It is well known that gestational weight gain (GWG) beyond what is recommended is linked to adverse maternal and neonatal outcomes. The majority of countries follow GWG standards from The Institute of Medicine (IOM), which are slightly outdated and based on observational trials in the United States and other high-income countries. As such, the World Health Organization (WHO) has advocated for more universal, contemporary guidelines that can be applied to diverse groups globally. These authors sought to evaluate existing evidence to assess the relationship between GWG and broad outcomes to inform such guideline development.
( Reg Anesth Pain Med 2025;50:828–834. doi:10.1136/rapm-2024-105444) A prospective observational study examined whether epidural anesthesia influences optic nerve sheath diameter (ONSD), a noninvasive indicator of intracranial pressure (ICP), in pregnant individuals with and without preeclampsia with severe features (PEC w/SF). Pre-eclampsia (PEC) is a significant contributor to maternal morbidity and mortality, often associated with complications such as cerebral edema, intracranial hemorrhage, and infarction. Because invasive ICP monitoring carries risks, ONSD measured via ocular ultrasonography has emerged as a reliable surrogate marker for assessing ICP. In this study, an increased ONSD was defined as a bilateral mean ONSD of >5.8 mm and indicates an ICP >20 mm Hg. The primary outcome was the change in ONSD from baseline to 3 minutes following epidural load between patients with PEC w/SF and normotensive pregnant patients.
( BJOG 2025;132:1789–1790. doi:10.1111/1471-0528.18315) The global increase in cesarean delivery rates (CDRs) has become a significant topic of discussion in obstetrics, with ongoing debate about what constitutes an optimal rate. A recent study by Moster and colleagues challenges earlier guidance from the World Health Organization (WHO), which suggested that CDRs between 10% and 15% were ideal. Their findings indicate that areas with a 10% CDR experienced nearly double the risk of neonatal encephalopathy and a 50% higher incidence of cerebral palsy compared to regions with a 20% rate. These results suggest that lower CDRs may not always correspond to better neonatal outcomes, prompting reconsideration of previously accepted benchmarks.
( N Engl J Med . 2025 Dec 4;393(22):2221–2242. doi: 10.1056/NEJMsa2514268) In the United States, changes in federal messaging surrounding vaccines have caused disruption to guidance for immunization, though it is known that respiratory illnesses such as respiratory syncytial virus (RSV), influenza, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19) can become severe and result in hospitalization, particularly in children under a year of age and in the elderly (65 and older). Recent changes in federal processes have underscored the need for independent evaluation of evidence surrounding these immunizations. This study is a systematic review of recent data surrounding respiratory virus epidemiology, vaccine and immunization efficacy and safety to formulate recommendations for the 2025-2026 respiratory virus season.
( Int J Obstet Anesth 2025;63:104700. doi:10.1016/j.ijoa.2025.104700) Epidural hematoma and epidural abscess are rare and potentially devastating neurological complications associated with obstetric neuraxial anesthesia (NA). Although NA is widely used in the United Kingdom, with ~190,000 obstetric labor epidurals administered each year, reliable contemporary data on the incidence and outcomes of these complications have been limited. This population-based study aimed to estimate the frequency of epidural hematoma and abscess in UK obstetric patients and to describe patterns of diagnosis, management, and maternal and neonatal outcomes.
( J Clin Anesth 2026;109:112102. doi:10.1016/j.jclinane.2025.112102) A study examined how introducing a thromboelastometry-guided protocol influences fibrinogen use and blood transfusion practices in women experiencing postpartum hemorrhage (PPH), a major contributor to maternal mortality worldwide. Coagulopathy plays a critical role in determining outcomes in PPH, and low fibrinogen (FIB) levels are strongly associated with progression to severe bleeding requiring transfusion. Although early FIB administration is common, its routine use without laboratory confirmation may lead to unnecessary treatment. Traditional coagulation tests are often delayed, limiting their usefulness in urgent situations. In contrast, point-of-care viscoelastic testing, such as rotational thromboelastometry (ROTEM), provides faster, real-time data to guide targeted therapy.
( Eur J Anaesthesiol . 2025 Sep 1;42(9):791–799. doi: 10.1097/EJA.0000000000002218) Placenta accreta spectrum (PAS), a condition where the placenta invades partially or completely into and through the myometrium, can be extremely challenging because of the risk of significant peripartum bleeding (PPH). Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has recently been implemented to help limit PPH in patients with PAS. REBOA uses an endovascular balloon to cause a temporary aortic occlusion to lower blood loss during cesarean delivery (CD) and prevent potential hysterectomy in certain cases. Currently, there are no established guidelines for its use in managing PAS cases.
( BJOG 2025; 132:1644–1654. doi: 10.1111/1471-0528.18289) This study investigated whether hemoglobin levels immediately after childbirth are linked to symptoms of postpartum depression (PPD) 2 months after vaginal delivery. Using data from a large multicenter randomized controlled trial conducted in France, researchers examined women with a singleton pregnancy who delivered vaginally at or beyond 35 weeks’ gestation. Women with known psychiatric conditions or missing depression screening data were excluded. The primary exposure was hemoglobin concentration measured within the first few days after delivery, while the outcome was depressive symptoms assessed using the Edinburgh Postnatal Depression Scale (EPDS), with a score of 11 or higher indicating PPD symptoms.
Eur J Anaesthesiol . 2025 Jul 1;42(7):626–636. doi: 10.1097/EJA.0000000000002180. While lumbar epidural analgesia (LEA) is the most effective pharmacologic labor pain management tool, its use varies significantly. Factors that impact a woman’s choice are not fully known, and there is a question of whether similar factors may impact risk for post-partum depression (PPD), and if the choice to receive (or not) LEA has any association with PPD. These authors investigated those factors and associations with a longitudinal cohort study conducted at Uppsala University Hospital in Sweden between 2010 and 2019 as part of a larger population-based project called the BASIC (Biology, Affect, Stress, Imaging and Cognition) study. The study included women who intended to have spontaneous vaginal deliveries who were at least 18 years old and spoke Swedish, and excluded those with twin pregnancies, elective cesarean delivery, or labor inductions.
Int J Obstet Anesth . 2025 May;62:104348 doi:10.1016/j.ijoa.2025.104348 Adequate pain control after cesarean delivery (CD) is crucial for maternal recovery and well-being, yet achieving adequate analgesia without opioid-related side effects remains a challenge. Intrathecal morphine (ITM) has long been a cornerstone of post-CD analgesia due to its reliable and prolonged pain relief. However, ITM is associated with adverse effects, most commonly pruritus, nausea, and vomiting, and in rare cases, respiratory depression. Determining the ideal ITM dose that balances pain relief with minimal side effects has been an ongoing focus. Previous trials compared low (50 to 100 µg) and high doses (>100 µg), finding longer analgesic duration with higher doses at the cost of more frequent side effects. Significantly, many studies predated modern multimodal analgesia protocols, which combine neuraxial opioids with acetaminophen and NSAIDs, reducing reliance on rescue opioids. These authors sought to provide a comparison of ITM doses and corresponding opioid requirements and side effects in the setting of a multimodal analgesia regimen.
Obstet Gynecol . 2025 Jan 1;145(1):65–71. doi: 10.1097/AOG.0000000000005770 The leading cause of severe maternal morbidity in the United States is postpartum hemorrhage (PPH), which complicates ~5% of deliveries. More than 30% of maternal deaths in low- and middle-income countries can be attributed to PPH, and many institutions have instituted standardized treatments in an effort to reduce maternal mortality due to hemorrhage. Recommendations include early recognition of blood loss, treatment with uterotonic agents, and using hemorrhage-control devices, interventional radiology, and standardized transfusion regimens. For years, the only devices available to control hemorrhage were intrauterine tamponade balloons (IUB); recently, the Jada system (intrauterine vacuum-induced hemorrhage-control device, V-IHCD) has gained traction, with two trials showing favorable results. This study was designed to compare and assess outcomes of balloon and vacuum hemorrhage-control devices when included in standard PPH care.
Eur J Anaesthesiol . 2025 Jun 1;42(6):508–517. doi: 10.1097/EJA.0000000000002155. Multiple sclerosis (MS) is an autoimmune disease affecting the central nervous system (CNS) and is estimated to affect 35.9 per 100,000 people globally. The prevalence of MS among adults at their most productive age of life has a significant impact on family, financial, and career goals; MS is 3 times more frequently diagnosed in women, with the typical age at diagnosis being between 20 and 30. The misconception that pregnancy could worsen MS symptoms has prevented many individuals with MS from becoming pregnant, though disease-modifying therapies (DMTs) developed recently have enabled more women to feel confident pursuing it. Though pregnancy itself is not an independent risk factor for the worsening of MS, there are risks during pregnancy that are associated with MS. This presents a challenge for clinicians and anesthesiologists as well in terms of optimizing patient safety and delivering adequate care. In the past, there have been additional concerns about the effects of local anesthetics in patients with MS, though there is no comprehensive evidence or clinical recommendations surrounding their use in this population. This study is a systematic review aimed at compiling evidence surrounding the use of anesthetic techniques in patients with MS and providing recommendations for technique selection.
Acta Obstet Gynecol Scand . 2025 Jun;104(6):1056–1069. doi: 10.1111/aogs.15119. Recent research has been calling attention globally to women’s negative experiences during childbirth, including for reasons such as mistreatment, abuse, or obstetric violence, which are encompassed by the term “disrespectful maternity care.” This disrespect can result from the behavior of health care practitioners and professionals or from the health care system. This is a subjective measure, as women who are uniquely vulnerable after childbirth can experience disrespect differently, and assessing the magnitude of this issue is imperative in understanding how to help women have positive experiences and minimize negative ones. This study was designed to assess disrespectful care during childbirth by evaluating how often individuals reported experiencing words, gestures, or attitudes that shocked, offended, or made them feel uncomfortable during childbirth and before discharge from the hospital.
Can J Anaesth. 2025 Aug;72(8):1314–1323. doi:10.1007/s12630-025-03006-1 Chronic postsurgical pain (CPSP), defined as pain persisting for at least 3 months after surgery, is a recognized complication following cesarean delivery (CD). While numerous studies have focused on perioperative and immediate postoperative factors associated with CPSP, less attention has been given to psychological conditions arising during the postpartum period. Postpartum depression (PPD), a common mental health disorder occurring shortly after childbirth, has been associated with adverse maternal outcomes, yet its relationship with CPSP remains insufficiently explored. This secondary analysis aimed to examine whether PPD following CD is associated with the development of CPSP and to evaluate whether PPD mediates the relationship between severe acute postoperative pain and later chronic pain.
