Pervez Sultan

• MBChB, FRCA, MD(Res)
• Professor at Stanford University School of Medicine

Background: Whilst validated quality-of-recovery (QoR) tools exist for general surgery, there is no specific obstetric equivalent. We aimed to develop and evaluate a modified QoR score after elective caesarean delivery. Methods: Twenty-two obstetric specific items were selected following review and modification of the QoR-40 survey by 16 experts an...

Background This systematic review aimed to determine whether enhanced recovery after caesarean delivery (ERAC) protocols should be adopted. Methods We searched four databases and abstracts from meetings for studies comparing ERAC to standard care. We report interventions, outcomes, qualitative impact of ERAC implementation and use GRADE scoring to...

Importance Despite the global delivery rate being approximately 259 deliveries per minute in 2018, postpartum recovery remains poorly defined. Objectives To identify validated patient-reported outcome measures (PROMs) used to assess outpatient and inpatient postpartum recovery, evaluate frequency of PROM use, report the proportion of identified PR...

We performed a systematic review using ‘consensus‐based standards for the selection of health measurement instruments’ (COSMIN) criteria to identify and evaluate the quality of patient‐reported outcome measures (PROM) instruments that have been utilised to assess functional recovery following caesarean section, and determine the optimal instrument...

Background Neuraxial anesthesia is the gold standard technique for cesarean delivery, however pain during cesarean delivery may be underreported. The primary aim of this systematic review and meta-analysis was to determine the incidence of patient reported intraoperative pain during cesarean delivery under neuraxial anesthesia. Methods A literatur...

BACKGROUND Childbirth can have a substantial impact on maternal health-related quality of life. Cesarean delivery is the most performed inpatient operation, yet little is known about normal postpartum recovery profiles. The primary aim of our study was to longitudinally evaluate global health visual analog scale (GHVAS; 0–100) scores up to 12 weeks...

( Anaesthesia. 2024;79:486–497. doi:10.1111/anae.16241) Discrepancies in maternal and neonatal results across diverse ethnic and socioeconomic groups have been thoroughly documented. The postnatal period is crucial to a mother’s health, as it is the time when most maternal deaths happen. Research has indicated that individuals from lower socioecono...

A BSTRACT Background The Obstetric Quality of Recovery-10 (ObsQoR-10) is a patient-reported outcome measure that provides a holistic assessment on the quality of in-hospital postpartum functional recovery. Validated across several countries in various languages, it has shown great potential for widespread global acceptance in both clinical practic...

( Obstet Gynecol. 2024;143(6):803–810. doi: 10.1097/AOG.0000000000005591) Sleep disturbances are common during pregnancy, with up to 42% experiencing issues such as insomnia. A high-risk group includes those hospitalized for pregnancy complications, although research in this area is limited. Approximately 1% of all pregnancies involve antepartum ho...

( J Clin Anesth. 2023;91:111263 I, https://doi.org/10.1016/j.jclinane.2023.111263 I) Nearly 7% to 9% of postpartum women have postpartum depression (PPD), which is a significant mood disorder. PPD can adversely influence postpartum recovery areas such as maternal-infant bonding, sleep, pain, cognitive function, and overall functionality. Suicide is...

( Anesth Analg. 2024;138(5):1142–1144. doi: 10.1213/ANE.0000000000006801) Artificial intelligence (AI) is a relatively new mainstream technology that has recently been applied in many different contexts. ChatGPT (Chat Generative Pre-Trained Transformer), created by OpenAI, has previously demonstrated competence in some aspects of clinical reasoning...

Background: Existing enhanced recovery after cesarean delivery (ERAC) professional society recommendations lack intersociety collaboration, multidisciplinary expert input and involvement of patient stakeholders. This initiative aimed to develop a multidisciplinary set of ERAC interventions endorsed by relevant US professional societies and patient...

Background Variability in obstetric anaesthetia practice and care delivered within the UK is under-explored. The ObsQoR study explored structures, processes, and outcomes of obstetric anaesthesia in 107 hospitals within the UK’s National Health Service, and the results of the hospital-level survey are reported here. Methods Hospitals were surveyed...

Background The relationship between the quality of inpatient versus outpatient obstetric postpartum recovery is under-explored. We examined the association between inpatient reported quality of recovery with outpatient global recovery, pain severity, pain interference, anxiety, and depression screening scores postpartum. Methods We conducted a mul...

The Gerard W. Ostheimer lecture is given annually to members of the Society for Obstetric Anesthesia and Perinatology. This lecture summarizes new and emerging literature that informs the clinical practice of obstetric anesthesiology. This is a narrative review of 2022 literature pertinent to maternal morbidity and mortality in all income settings...

Background The expansion of artificial intelligence (AI) within large language models (LLMs) has the potential to streamline healthcare delivery. Despite the increased use of LLMs, disparities in their performance particularly in different languages, remain underexplored. This study examines the quality of ChatGPT responses in English and Japanese,...

( Anaesthesia . 2023;78(9):1071–1080) The peripartum period, encompassing childbirth and its aftermath, involves the administration of anesthesia or analgesia to ∼65% of patients, a substantial portion necessitated by urgent surgical interventions. The imperative to enhance surgical recovery and ensure patient satisfaction postpartum is crucial for...

Background The potential effect modification of sleep on the relationship between anxiety and elevated blood pressure (BP) in pregnancy is understudied. We evaluated the relationship between anxiety, insomnia, and short sleep duration, as well as any interaction effects between these variables, on BP during pregnancy. Methods This was a prospectiv...

Background Patients are increasingly using artificial intelligence (AI) chatbots to seek answers to medical queries. Methods Ten frequently asked questions in anaesthesia were posed to three AI chatbots: ChatGPT4 (OpenAI), Bard (Google), and Bing Chat (Microsoft). Each chatbot's answers were evaluated in a randomised, blinded order by five residen...

Given the global maternal health crisis and growing maternal morbidity, there is an urgent need to understand the public health implications of poor recovery after caesarean delivery (CD), in a subset of patients. Chronic post surgical pain is an ideal model to study this in depth, as it is implicated in multi-morbidity and is potentially modifiabl...

This Delphi develops a final core outcome domain set for inpatient pain assessment after caesarean delivery (Pain intensity - at rest, with movement, pain relief; Pain interference, Total opioid consumption and Maternal adverse effects). This abstract also introduces the outcome measures currently undergoing Delphi round voting.

OBJECTIVE To evaluate whether antepartum hospitalization was associated with differences in sleep duration or disrupted sleep patterns. METHODS This was a prospective cohort study with enrollment of pregnant people aged 18–55 years with singleton gestations at 16 weeks of gestation or more between 2021 and 2022. Each enrolled antepartum patient wa...

Background Spanish is the second most spoken language globally with around 475 million native speakers. We aimed to validate a Spanish version of the Obstetric Quality of Recovery-10 item (ObsQoR-10) patient-reported outcome measure. Methods ObsQoR-10-Spanish was developed using EuroQoL methodology. ObsQoR-10-Spanish was assessed in 100 Spanish-sp...

Disparities relating to postpartum recovery outcomes in different socio‐economic and racial ethnic groups are underexplored. We conducted a planned analysis of a large prospective caesarean delivery cohort to explore the relationship between ethnicity, socio‐economic status and postpartum recovery. Eligible patients were enrolled and baseline demog...

Background The role of continuous wound infusion catheters as part of a multimodal analgesia strategy after Caesarean delivery is unclear. We introduced continuous wound infusion catheters to our multimodal analgesia regimen to evaluate the impact on analgesic outcomes after Caesarean delivery. Methods After institutional review board (IRB) approv...

Importance: Dural-puncture epidural (DPE) and standard epidural are common modes of neuraxial labor analgesia. Little is known about conversion of DPE-initiated labor analgesia to surgical anesthesia for cesarean delivery. Objective: To determine whether DPE provides a faster onset and better-quality block compared with the standard epidural tec...

Objective: To perform a systematic review and evaluate the psychometric measurement properties of instruments in postpartum anxiety using Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines and identify the best available patient-reported outcome measure. Data sources: We searched 4 databases (CINAHL...

Background: Neuraxial opioids provide effective analgesia for Caesarean delivery, however, pruritus can be a troubling side-effect. Effective agents to prevent pruritus are needed. Our objective was to perform an updated systematic review and network meta-analysis to provide clinicians with a comparison of relative efficacy of available interventi...

To better understand outcomes in postpartum patients who receive peripartum anaesthetic interventions, we aimed to assess quality of recovery metrics following childbirth in a UK-based multicentre cohort study. This study was performed during a 2-week period in October 2021 to assess in- and outpatient post-delivery recovery at 1 and 30 days postpa...

( Anesthesiology . 2022;137:201–211) Obstetric units are increasingly using enhanced recovery after cesarean delivery (ERAC) protocols. A number of studies have shown ERAC protocols reduce opioid consumption, length of hospital stay, and time to mobilization. There have been a wide range of outcomes by which to evaluate ERAC protocols, making it ch...

Background: Inpatient postpartum recovery trajectories following cesarean delivery and spontaneous vaginal delivery are underexplored. Objective: This study primarily aimed to compare recovery following cesarean delivery and spontaneous vaginal delivery in the first postpartum week, and secondarily to evaluate psychometrically the Japanese versi...

Background: Cesarean section is associated with moderate to severe pain and nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly employed. The optimal NSAID, however, has not been elucidated. In this network meta-analysis and systematic review, we compared the influence of control and individual NSAIDs on indices of analgesia, side effects a...

Epidural-related maternal fever affects 15% to 25% of patients who receive a labor epidural. Two meta-analyses demonstrated that epidural-related maternal fever is a clinical phenomenon, which is unlikely to be caused by selection bias. All commonly used neuraxial techniques, local anesthetics with or without opioids, and maintenance regimens are a...

(Anaesthesia. 2022;77:598–604) While neuraxial anesthesia (NA) is often a common and safe form of anesthesia, it does not always properly manage pain, especially during cesarean delivery (CD). Previous studies determining the rate of inadequate NA during CD have small sample sizes and different diagnostic criteria, resulting in a wide range of repo...

Objective To describe the prevalence and predictors of postpartum sleep disorders. Design A retrospective cohort study. Setting Postpartum. Population Commercially insured women delivering in California (USA) between 2011 and 2014. Methods Using the Optum Clinformatics Datamart Database. Main outcome measures Prevalence of a postpartum sleep d...

Enhanced recovery after cesarean delivery (ERAC) is a protocolized approach to perioperative care, with the aim to optimize maternal recovery after surgery. It is associated with improved maternal and neonatal outcomes, including decreased length of hospital stay, opioid consumption, pain scores, complications, increased maternal satisfaction and i...

OBJECTIVE To evaluate red blood cell use during delivery in patients with placenta accreta spectrum. DATA SOURCES We searched MEDLINE, EMBASE, CINAHL, Cochrane Central, ClinicalTrials.gov, and Scopus for clinical trials and observational studies published between 2000 and 2021 in countries with developed economies. METHODS OF STUDY SELECTION Abst...

( Anaesthesia . 2022;77:463–474. doi: 10.1111/anae.15645) With cesarean delivery (CD) rates on the rise globally, it is important to understand the most effective methods of managing postoperative pain, which can be moderate to severe. Effective analgesia following CS has the long-term benefits such as decreasing opioid consumption, postpartum depr...

(BJOG. 2022;129:9–20) Although ~3.8 million people have children per year, few people have researched postpartum recovery. This may be because tools developed to measure postpartum recovery, such as the Obstetric Quality of Recovery instrument, have not been used, validated, or developed sufficiently. The authors of this study previously created a...

Background: Fatigue is a burden for a substantial proportion of women in the postpartum period. A wide array of patient-reported outcome measures (PROMs) are used for assessment, which makes comparison of data difficult. Objective: To identify the best PROM for postpartum fatigue using Consensus-Based Standards for the Selection of Health Measurem...

Objective: The 10-item Obstetric Quality-of-Recovery 10 scale is a validated patient-reported outcome questionnaire that measures the quality of recovery following delivery. This study aims to develop a Turkish version of the Obstetric Quality of Recovery 10 to evaluate its validity, reliability, and clinical feasibility. Methods: Term parturien...

Background : To reduce postpartum morbidity and mortality. optimizing routine outpatient postpartum care has become a focus of national attention and healthcare priority. Objective : The objective of this study was to examine the timing, content, and predictors of routine outpatient postpartum visit attendance within a large, commercially-insured...

High-frequency jet ventilation (HFJV) can reduce organ movement that otherwise complicates percutaneous image-guided ablation (IGA) procedures. This study describes feasibility and safety of the technique in routine use. We describe our method for the use of HFJV and present 169 consecutive cases, including IGA of tumors of the lung, liver, kidney,...

Objective: The goal of this systematic review is to assess the incidence, prevalence, and timing of common postpartum (up to one year after delivery) medical, surgical/procedural, and psychosocial complications and mortality. Introduction: Childbirth is the most common cause for hospitalization, and cesarean delivery is the most commonly perform...

Background The management of obstetric patients with coronavirus disease 2019 (COVID-19) due to human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires unique considerations. Many aspects of labour and delivery practice required adaptation in response to the global pandemic and were supported by guidelin...

Importance: Maternal depression is frequently reported in the postpartum period, with an estimated prevalence of approximately 15% during the first postpartum year. Despite the high prevalence of postpartum depression, there is no consensus regarding which patient-reported outcome measure (PROM) should be used to screen for this complex, multidime...

Background Heterogeneity among reported outcomes from enhanced recovery after cesarean delivery impact studies is high. This study aimed to develop a standardized enhanced recovery core outcome set for use in future enhanced recovery after cesarean delivery studies. Methods An international consensus study involving physicians, patients and a dire...

[This corrects the article DOI: 10.1016/j.bjae.2021.12.008.].

Background: We aimed to develop and validate a Portuguese version of the Obstetric Quality of Recovery-10 (ObsQoR-10-Portuguese) patient-reported outcome measure and evaluate its psychometric properties. Methods: After ethical approval, we recruited term pregnant women undergoing uncomplicated elective cesarean delivery in a single Brazilian ins...

Background Fatigue is a burden for a substantial proportion of women in the postpartum period. A wide array of patient-reported outcome measures (PROMs) are used for assessment, which makes comparison of data difficult. Objective To identify the best PROM for postpartum fatigue using Consensus Based Standards for the Selection of Health Measurement...

( Anaesthesia . 2021;76:393–403. doi: 10.1111/anae.15160. Epub July 4, 2020) Cesarean deliveries (CD) are the most globally performed surgical operation, thus it is important to improve postoperative pain following CD. The typical approach for improved analgesia outcomes following CD is multimodal analgesia (including long-acting intrathecal and ep...

Placenta praevia occurs when the placenta is inserted wholly or partly into the lower segment of the uterus. The placenta can be implanted in a variety of places on the uterus, including anterior, posterior, fundal, and praevia.

Umbilical cord prolapse is an obstetric emergency in which the umbilical cord descends through the cervix alongside (occult) or past (overt) the presenting part of the baby. Pressure on, or spasm of, the umbilical cord impairs the flow of blood between the placenta and fetus, leading to fetal hypoxia.

Coronavirus disease 2019 (COVID-19), caused by novel coronavirus (named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) presents unique challenges to obstetric healthcare workers, in particular to anesthesiologists.

Pregnant women should be offered information based on current available evidence together with support to enable them to make informed decisions about their care. This information should include where they will be seen and who will undertake their care.

Cervical cerclage involves the placement of a circumferential suture at various anatomical sites along the length of the cervix to prevent pregnancy loss in women with cervical insufficiency. The procedure can be indicated by history, ultrasound imaging or physical examination. Contraindications include multiple pregnancy, chorioamnionitis, ongoing...

The reported incidence of failure of spinal anaesthesia for caesarean delivery (CD) varies widely from less than 1% through to 17%.

Caesarean delivery (CD) is a surgical procedure, which involves an incision through various layers of the abdominal wall and uterus to deliver the fetus.

Pre-term labour (PTL) refers to the presentation of symptoms and signs of labour before 37 weeks of gestation. It may be suspected, diagnosed or established pre-term labour depending on the history, clinical examination and investigations.

The rate of failure for epidural analgesia in labour is approximately 12–14% and should be discussed when consenting the patient. for neuraxial labour analgesia.

Placenta accreta spectrum refers to conditions where the placenta implants over a previous uterine scar (for example after a previous caesarean delivery or uterine surgery). The morbidly adherent placenta penetrates through the decidua basalis and through the myometrium to a varying degree. This results in the placenta being unable to separate from...

There is no universal definition for intrapartum fever (IPF). UK guidelines define IPF as maternal temperature ≥38 °C on a single occasion or two temperature readings ≥37.5 °C one hour apart, whereas US guidelines define IPF as maternal oral temperature ≥39 °C on a single occasion, or two oral temperature readings 38–38.9 °C, 30 min apart.

Enhanced recovery after cesarean delivery (ERAC) is increasingly used worldwide with the aim to improve patient care for women undergoing this procedure. ERAC is associated with superior maternal outcomes including decreased length of hospital stay, reduced readmission rates, and lower opioid consumption. A number of pre-, intra- and postoperative...

Neuraxial anaesthesia is widely utilised for elective caesarean section, but the prevalence of inadequate intra‐operative anaesthesia is unclear. We aimed to determine the prevalence of inadequate neuraxial anaesthesia for elective caesarean section; prevalence of conversion from neuraxial anaesthesia to general anaesthesia following inadequate neu...

The demand on obstetric anaesthetists is ever increasing, with the majority of women being cared for within hospital delivery areas, requiring their services. Caring for obstetric patients is very different compared to caring for patients in other surgical settings. Obstetric anaesthetists will frequently administer neuraxial anaesthesia for surgic...