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Background <p>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.</p> Methods <p>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.</p> Results <p>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.</p> Conclusions <p>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.</p> Trial registration <p>ClinicalTrials.gov (NCT04912791), registered June 2, 2021.</p>

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

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  • 发表日期：

    2026年7月8日

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  • Jan Bláha,
  • Pavlína Nosková,
  • Dagmar Seidlová,
  • Monika Grochová,
  • Radka Klozová,
  • Josef Firment,
  • Hana Harazim,
  • Kateřina Kusalová,
  • Michal Svoboda,
  • Deana Slovjaková,
  • Nela Rezbáriková,
  • Quynh Giang Nguyenová,
  • Petr Štourač,
  • Miriama Kaščáková,
  • Klára Fabiánková,
  • Jaroslava Ščamburová,
  • Petr Reimer,
  • Monika Burešová,
  • Richard Tesařík,
  • Pavel Kettner,
  • Xénia Silová,
  • Christian Kufa,
  • Marie Chaloupecká,
  • Nikola Bandíková,
  • Alena Baničová,
  • Libor Machát,
  • Tomáš Čechmánek,
  • Pavel Longin,
  • Pavel Neumann,
  • Jana Mahdalová,
  • Tomáš Piksa,
  • Terézia Klenová,
  • Jiří Pařízek,
  • Hana Pachovská,
  • David Míra,
  • Kristýna Kalinová,
  • Edita Langrová,
  • Jan Němec,
  • Marián Olejník,
  • Michal Houfek,
  • Petra Běhounková,
  • Jana Daňová,
  • Marek Proksa,
  • Veronika Richterová,
  • Petr Štěpánek,
  • Jana Popieluchová,
  • Jana Pěkná,
  • Ladislav Rychtárik,
  • Lucie Chamrová,
  • Josef Kubík,
  • Gabriela Pohořelá,
  • Jakub Bala,
  • Martin Hudymač,
  • Jaroslava Márová,
  • Monika Ďuricová,
  • Prokop Seif,
  • Jiří Cetkovský,
  • Radek Majerčin,
  • Zdeněk Kos,
  • Radovan Prchlík,
  • Jaroslav Čupera,
  • Kazimír Kovář,
  • Dušana Bednářová,
  • Martin Dvořák,
  • Petr Vašíček,
  • Marek Spyra,
  • Soňa Fajstauerová,
  • Pavel Kopecký,
  • Ivo Schindler,
  • Marek Zbořil,
  • Martin Šimák,
  • Eva Smržová,
  • Vladislav Černý,
  • Lukáš Rokos,
  • Milan Náprstek,
  • Daniel Kmec,
  • Petr Kozár,
  • Vladimír Zemánek,
  • Igor Krupa,
  • Petr Kudrna,
  • Martina Bělorová,
  • Mária Petrisková,
  • Jana Morávková,
  • Jakub Vallo,
  • Hana Malérová,
  • Renáta Toboláková,
  • Matúš Pauliny,
  • Dária Rábarová,
  • Ľubomíra Romanová,
  • Michal Blanár,
  • Jana Buranská,
  • Katarína Galková,
  • Jana Šimonová,
  • Božena Horanová,
  • Michal Venglarčík,
  • Ľuboš Filiač,
  • Stanislava Richterová,
  • Adam Antolík,
  • Marek Pastir,
  • Dušan Kostovčík,
  • Sharifullah Azizi,
  • Mária Šramková,
  • Ľubica Mišáková,
  • Serhiy Rak,
  • Ivo Horský,
  • Zuzana Baluchová,
  • Dávid Druska,
  • Lucia Cifraničová,
  • Eva Fašánková,
  • Ľuba Jurčíková,
  • Stanislav Saladiak,
  • Ivana Ivanová

摘要

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.