- Design
- Multicentre prospective cohort, 361 centres in 31 European countries
- Population
- 9,989 Caesarean deliveries without exclusion criteria
- Primary outcome
- Anaesthesia technique by urgency category
- Effect
- GA 14.8% overall; 54.0% emergency vs 10.9% elective; conversion 7.7% of neuraxial cases
This prospective cohort included every Caesarean delivery, with no exclusions, at 361 centres in 31 European countries between September 2023 and April 2025. Anaesthetists recorded urgency on a four-level scale and the technique used. In all, 9,989 deliveries were captured.
General anaesthesia was used in 14.8% overall (95% CI 14.0 to 15.5): 54.0% of emergency, 13.8% of urgent, 11.3% of expedited and 10.9% of elective cases. It was the first-choice technique in 7.6%. In elective cases, the commonest reason for planned general anaesthesia was maternal request (47%); in emergencies, it was lack of time for a neuraxial block (58.4%). Conversion from neuraxial to general anaesthesia occurred in 7.7% of 9,228 neuraxial cases, in 23.1% of emergencies and 6.1% of elective cases.
The study is descriptive and cannot explain the variation between countries, but two numbers stand out. A conversion rate above 6% in elective cases, where time is not the constraint, points to block failure that better testing and supplementation might reduce. And the high general anaesthesia rate in emergencies is where early epidural top-up planning on the labour ward has most to offer.
- Audit your own unit's conversion rate from neuraxial to general anaesthesia, by urgency category.
- Test and document the block height before every Caesarean, including elective cases.
- Assess labour epidurals early so they can be topped up if an emergency Caesarean is called.
- Prepare for difficult airway management in every emergency Caesarean, given how often general anaesthesia is needed.
- Explore the reasons behind a request for general anaesthesia in elective cases.
Why it matters
One elective Caesarean in about sixteen started neuraxially ended under general anaesthesia, which is higher than many units assume.
Don't overread it
The study describes practice and cannot say why rates differ or what the right rate is.
The statistics, in plain English
The narrow interval around 14.8% reflects a large sample, so the overall estimate is precise. But the study pools 31 countries with different practices, so a unit's own rate may differ substantially and the figures describe practice rather than set a target.
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