Early Labour Epidural for Parturients With High BMI-A National Danish Survey

Obesity in pregnancy increases obstetric and anaesthetic risk. Although early neuraxial access is frequently recommended for parturients with high BMI, the evidence base is limited, and national implementation has not been investigated. We aimed to describe current Danish practise regarding 'early labour epidural' for parturients with high BMI.

We conducted a national cross-sectional survey of the head of obstetric anaesthesiology at all 22 Danish hospitals with labour units (November 2024) with a 100% response rate. The questionnaire covered definitions, organisation, assessment, and management of 'early labour epidural'. Demographic context (2014-2024) was obtained from the Danish national Birth Register. Time trends in BMI > 40 kg/m² prevalence and epidural use among parturients with BMI > 40 were analysed by binomial logistic regression using aggregated yearly counts.

From 2014 to 2024, the proportion of parturients with BMI > 40 kg/m² increased from 1.4% to 1.9%, while epidural use in this group rose from 42% to 58% (both p < 0.0001). Most departments defined 'high BMI' as > 40 kg/m², but thresholds varied. Local guidelines existed in 64%, and 86% reported routine antenatal anaesthetic assessment. Written patient information was provided at 17% of centres. Definitions of 'early labour epidural' differed, and 32% reported no formal definition. A written departmental guideline was present in 68%. Ultrasound for epidural placement was used routinely in 10% and selectively in 60%, while antenatal lumbar ultrasound was performed in 32%. Test dosing, maintenance regimens, and intrapartum management strategies varied widely.

In Denmark, management of 'early labour epidural' for parturients with high BMI varies considerably regarding definitions, antenatal assessment, and intrapartum practise. This variation persists despite an increasing prevalence of obesity in pregnancy and a rising use of epidural analgesia. Our findings provide an overview of current national practise and highlight areas where further evidence and consensus are needed, including the development of evidence-based national standards.

This national Danish survey identified substantial variation in the management of early labour epidurals for women with high BMI, where there are increasing obesity rates and epidural use. The findings reveal a clear evidence-practice gap and support the need for national, evidence-based guidelines. Strengths include complete national participation (100% response rate), use of registry data for clinical context, and responses reflecting institutional practice. Limitations include reliance on self-reported data, lack of patient outcome measures and limited generalisability beyond Denmark.