Anesthetic management of women with primary immunodeficiencies in the obstetric setting: A French cohort study (ANEU-DIP)

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Background: Primary immunodeficiencies (PIDs) encompass a large group of inherited diseases affecting the immune system. PID management is improving, enabling more patients to carry a pregnancy to term. Anesthetic care of those patients, especially obstetric neuraxial anesthesia and the associated infectious complications, has never been evaluated in this population. Objective: This retrospective multicenter study aimed to assess the anesthetic management of women with PIDs during childbirth, focusing on potential infectious complications related to neuraxial anesthesia. Methods: The medical records of 30 women aged 18 years or older, who are included in the French national PID registry (Reference Centre for Primary Immunodeficiencies [CEREDIH]) and who gave birth at one of the Assistance Publique-Hôpitaux de Paris maternity units between 2014 and 2024, were analyzed. Data on PID history, obstetric outcomes, and peripartum anesthesia were collected (the ANEU-DIP study, ClinicalTrials.gov identifier NCT06449066). Results: We examined 51 deliveries (including 20 cesarean sections) among 30 women with PIDs (13 with predominantly antibody defects, 11 with T-cell immune deficiencies, and 6 with innate immune deficiencies). Of the 49 locoregional anesthesia procedures performed, 36 were epidurals, 8 were spinals, and 5 were combined spinal-epidurals. No anesthesia-related complications were reported. The distribution and severity of PIDs in the cohort were consistent with those in other French studies. Three intrauterine infections were identified, of which 2 were associated with known risk factors and subsequent favorable maternal and neonatal outcomes. Conclusion: This study highlights the frequent use of neuraxial anesthesia in women with PIDs. No anesthesia-related complications were observed. Further research is needed to implement tailored anesthesia guidelines for this vulnerable segment of the pregnant population.

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