{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T04:05:22Z","timestamp":1784693122946,"version":"3.55.0"},"reference-count":19,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2026,8]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n 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 \u2018early labour epidural\u2019 for parturients with high BMI.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We conducted a national cross\u2010sectional 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 \u2018early labour epidural\u2019. Demographic context (2014\u20132024) was obtained from the Danish national Birth Register. Time trends in BMI\u2009>\u200940\u2009kg\/m\n 2<\/jats:sup>\n prevalence and epidural use among parturients with BMI >\u200940 were analysed by binomial logistic regression using aggregated yearly counts.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n From 2014 to 2024, the proportion of parturients with BMI\u2009>\u200940\u2009kg\/m\n 2<\/jats:sup>\n increased from 1.4% to 1.9%, while epidural use in this group rose from 42% to 58% (both\n p<\/jats:italic>\n \u2009<\u20090.0001). Most departments defined \u2018high BMI\u2019 as >\u200940\u2009kg\/m\n 2<\/jats:sup>\n , 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 \u2018early labour epidural\u2019 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.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n In Denmark, management of \u2018early labour epidural\u2019 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\u2010based national standards.<\/jats:p>\n <\/jats:sec>\n \n Editorial Comment<\/jats:title>\n 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\u2013practice gap and support the need for national, evidence\u2010based 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\u2010reported data, lack of patient outcome measures and limited generalisability beyond Denmark.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/aas.70297","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T06:54:19Z","timestamp":1783061659000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Labour Epidural for Parturients With High\n BMI<\/scp>\n \u2014A National Danish Survey"],"prefix":"10.1111","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8665-4889","authenticated-orcid":false,"given":"Julie","family":"Bruun","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Odense University Hospital Odense Denmark"},{"name":"Department of Anaesthesiology and Intensive Care University Hospital of Southern Denmark Kolding Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6848-8143","authenticated-orcid":false,"given":"Anne Juul","family":"Wikkels\u00f8","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Medicine Zealand University Hospital Roskilde Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5988-4563","authenticated-orcid":false,"given":"Helene Korvenius","family":"Nedergaard","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care University Hospital of Southern Denmark Kolding Denmark"},{"name":"Department of Regional Health Research University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000107291.46159.00"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000935"},{"key":"e_1_2_10_4_1","unstructured":"Danish Association for Anaesthesiology and Intensive Care \u201cNational Guideline for Labour Epidural 2024 \u201dhttps:\/\/dasaim.dk\/guides\/foedeepidural\/."},{"key":"e_1_2_10_5_1","unstructured":"\u201cNorsk Anestesiologisk Forening\u2014Metodebok for F\u00f8dselsanestesi \u201dhttps:\/\/metodebok.no\/emne\/nNjze9L9\/epidural\u2010analgesi\/anestesi."},{"key":"e_1_2_10_6_1","unstructured":"SFAI \u201cRiktlinje f\u00f6r Analgesi vid F\u00f6rlossning: Epidural Och Spinal 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