Valdimar Bersi Kristjánsson^1,2

Embla Ýr Guðmundsdóttir^3,4

Sigurbjörg Skarphéðinsdóttir¹

Helga Gottfreðsdóttir^3,5

Ragnheiður I. Bjarnadóttir^2,5

¹Department of Anesthesia and Intensive Care, Landspítali University Hospital, ²Faculty of Medicine, University of Iceland, ³Faculty of Nursing and Midwifery, University of Iceland, ⁴The Reykjavík Birth Center, ⁵Department of Obstetrics and Gynaecology, Landspítali University Hospital.

Correspondence: Valdimar Bersi Kristjánsson, valdimak@landspitali.is

Key words: caesarean section, pregnancy, anaesthesia, migrant women, Human Development Index, obstetrics.

INTRODUCTION: General anaesthesia for emergent caesarean section, though uncommon, is vital in expediting deliveries. Studies indicate higher complication risks among pregnant migrant women. This research investigates if migrant women in Iceland are more likely to undergo general anaesthesia for emergent caesarean section compared to their Icelandic counterparts.

MATERIALS AND METHODS: This population-based cohort study analysed 4,415 emergency caesarean sections in Iceland between 2007 and 2018, sourced from the National Birth Registry. Participants were categorized by citizenship, with migrants further stratified by their country's Human Development Index (HDI). NCSP-IS and ICD-10 codes indexed diseases, interventions, and complications. The impact of variables was assessed through multiple logistic regression analysis.

RESULTS: Migrant women received general anaesthesia in 16.1% of cases, slightly surpassing Icelandic women's 14.6%. Adjusting for risk factors showed no increased risk for migrant women. However, they had a higher likelihood of urgent caesarean sections (OR 1.45, 95% CI 1.08-1.94, p=0.015), a known risk factor for general anaesthesia, despite fewer comorbidities. Adjusting for confounders revealed reduced odds with a history of previous caesarean section (aOR 0.73, 95% CI 0.59-0.89, p=0.003) and placement of epidural anaesthesia in the delivery room (aOR 0.49, 95% CI 0.40-0.60, p<0.001).

CONCLUSIONS: Migrant women in Iceland do not face increased risks of general anaesthesia for emergent caesarean sections. However, their elevated risk of urgent caesarean sections suggests potential challenges, including language barriers or inadequate antenatal care. Early information dissemination and targeted interventions may mitigate these risks in this vulnerable community.