Effect of ethnicity and body mass index on the distance from skin to lumbar epidural space in parturients

Sharma, Vijay; Swinson, A.K.; Hughes, Claire; Mokashi, S.; Russell, Robin

doi:10.1111/j.1365-2044.2011.06812.x

Cited by 23 publications

(28 citation statements)

References 15 publications

(23 reference statements)

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“…Thirteen studies were from the UK (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39), three from Australia (40,41), two from Norway (42,43) and Canada (44,45), and one from USA (46) and Spain (47) ( Table 1). Some studies used more than one exposure: 21 studies used maternal anthropometric measurements as the exposure (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(43)(44)(45)(46)(47)(48) (group 1), three used gestational change in maternal anthropometrics as the exposure (31,42,47) (group 2) and two used a combination of pre-pregnancy anthropometrics and gestational change in anthropometrics (42, 43) (group 3). Of the studies that used maternal BMI as a categorical exposure (n = 7), only three studies applied BMI criteria for South Asian populations (29,46,48).…”

Section: Resultsmentioning

confidence: 99%

“…We also searched citations and reference lists of included studies, and the reference lists of reviews that were related to the topic area. Of the 22 included studies, 20 were identified through database search alone (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(42)(43)(44)(45)(46)48), one from screening the reference lists of relevant reviews (41) and one from searching the citations of included studies (47). In their recent review and meta-analysis, Heslehurst et al also found that in order to minimize bias, it was essential to include evidence from searches in addition to database searching (7).…”

Section: Discussionmentioning

confidence: 99%

“…One study found that distance from skin to epidural space increased with increasing BMI; this was lower in South Asian women than in White women (36) (Table S5). In women with post-natal IGT, mean weight was lower for South Asian women (68.3 kg) than for White women (79.9 kg) (37).…”

Section: Pregnancy Outcomes With Evidence Available From One or Two Smentioning

confidence: 99%

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Effects of maternal anthropometrics on pregnancy outcomes in South Asian women: a systematic review

et al. 2018

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SummaryAimThis systematic review investigates associations between maternal pre‐pregnancy/early‐pregnancy anthropometrics (e.g. weight and body fat), anthropometric change and pregnancy outcomes in South Asian and White women.MethodsTwelve electronic literature databases, reference lists and citations of all included studies were searched. Observational studies published in the English language were included. Descriptive synthesis was used to summarize the evidence base.ResultsTwenty‐two studies met the inclusion criteria (403,609 births [351,856 White and 51,753 South Asian]). Nine were prospective cohort studies, nine were retrospective cohort studies and two were cross‐sectional studies. Results suggested that in South Asian women, maternal pre‐pregnancy/early‐pregnancy anthropometrics were associated with anthropometric change, birthweight, mode of delivery and gestational diabetes mellitus (GDM). Gestational anthropometric change was found to be associated with GDM. There was limited evidence to suggest that there may be associations between maternal pre‐anthropometrics/early anthropometrics and hypertensive disorders, stillbirth, congenital anomalies, post‐natal weight retention and post‐natal impaired glucose tolerance. The evidence suggested a combined effect of pre‐pregnancy/early‐pregnancy anthropometrics and gestational anthropometric change on both GDM and post‐natal weight retention.ConclusionThe increased risk of adverse pregnancy outcomes in South Asian women should be considered in guidelines for weight management before and during pregnancy.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effects of maternal anthropometrics on pregnancy outcomes in South Asian women: a systematic review

et al. 2018

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“…9 Sharma reported that ethnicity was related to epidural depth and BMI, possibly related to body shape 9 ; however, the body shapes of the investigated women according to ethnicity were not reported. 22,23 Only 27% of the women had all four reviewers' agreement regarding body shape. Traditional body shape allocation is done with front and side views 9 ; however, we used back views, congruent with anesthesia providers' observations prior to neuraxial block placement, and the pregnant belly likely distracts from shape categorization using side views.…”

Section: Discussionmentioning

confidence: 99%

Prospective observational investigation of body habitus measurements and relationship to epidural depth in term pregnant women

Weiniger

Cohen

Aptekman

et al. 2020

Acta Anaesthesiol Scand

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Background High body mass index (BMI) can predict difficult neuraxial block; however, fat distribution may also be important. The primary study aim was to identify body habitus and fat distribution measurements that correlated with ultrasound measured epidural depth. We hypothesized that measurements such as midarm and subscapular fatpad thicknesses and length of cervical spine may correlate better with ultrasound measured epidural depth than a global measure of BMI. Methods Prospective IRB approved study of term pregnant women requiring neuraxial block. We measured height, weight (BMI, kg/m2), subscapular, midarm fatpad thickness (digital caliper, mm), vertebral column length (C7 to sacral hiatus, cm) and epidural depth (ultrasound, mm). Four experts assessed photographs to assign anticipated difficult neuraxial block in sitting and lateral positions (5‐point Likert scale, 1 = very easy, 5 = very difficult). Results In all, 131 women completed body habitus measurements. Measured mean (standard deviation) BMI was 30.3 (5.4) kg/m2. Measured BMI, subscapular fatpad and midarm fatpad thickness were significantly correlated with ultrasound depth to epidural space (R2 0.733, 0.626 and 0.633, respectively, P < .0001) but vertebral column length was not. The experts had a high level of agreement (Cronbach's alpha >0.7) for assessment of anticipated difficult block in the sitting and lateral positions; however, anticipated difficult block was not correlated with epidural depth measured by ultrasound for sitting position, R2 = −0.015, P = .87; and lateral position, R2 = −0.087, P = .33. Conclusions Measurements of body habitus and fat distribution were no better than measured BMI to anticipate greater ultrasound measured depth to epidural space. Clinical trial number: Non‐interventional observational study, not registered.

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“…Il mesure quelques millimètres dans son axe antéro-postérieur (0,9 cm ± 0,5) et cette distance augmente avec l'IMC [10]. Bien que la distance peau-EPD augmente avec l'IMC [10,11], elle est en moyenne de 5 à 7 cm [10,11] chez la majorité des parturientes obèses. L'utilisation d'une aiguille de Tuohy de taille standard (90 mm) reste donc recommandée.…”

Section: Recherche De L'epd Difficile : Nombreux Faux Positifsunclassified

Bloc neuroaxiaux chez la parturiente obèse

Hesbois

Fuzier

Heintzelmann

et al. 2015

Le Praticien en Anesthésie Réanimation

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Effect of ethnicity and body mass index on the distance from skin to lumbar epidural space in parturients

Cited by 23 publications

References 15 publications

Effects of maternal anthropometrics on pregnancy outcomes in South Asian women: a systematic review

Effects of maternal anthropometrics on pregnancy outcomes in South Asian women: a systematic review

Prospective observational investigation of body habitus measurements and relationship to epidural depth in term pregnant women

Bloc neuroaxiaux chez la parturiente obèse

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