Recommendation ID

Does the use of ultrasound of the lumbar spine improve siting of regional anaesthetic needles in pregnant women with a BMI over 30 kg/m2 at the booking appointment?

Any explanatory notes
(if applicable)

Why the committee did not make a recommendation and made a research recommendation

The committee was aware that women who are obese are more likely to need anaesthesia during labour and birth. The rates of operative birth are much higher in this group, particularly in women with a BMI over 40 kg/m2. It's helpful for care planning if an anaesthetist is told when a woman with a BMI over 40 kg/m2 is admitted. Needle siting for anaesthesia is potentially more difficult in women who are obese because the surface landmark anatomy of the lumbar spine can be more difficult to identify. It is thought that there are more unsuccessful attempts to site regional analgesia, and ultrasound might be cost effective for needle siting in this group. The use of ultrasound for needle siting is increasing with resource implications for the NHS. The committee could not make a recommendation on the most appropriate technique for needle siting because the evidence was uncertain, but they agreed to make a research recommendation to inform future guidance.

Source guidance details

Comes from guidance
Intrapartum care for women with existing medical conditions or obstetric complications and their babies
Date issued
March 2019

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 06/03/2019