Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Clinical Research

Risk factors for post-caesarean nausea and vomiting: a prospective prognostic study

Fatores de risco para náusea e vômitos após cesariana: estudo prognóstico prospectivo

Gabriel Magalhães Nunes Guimarães, Helga Bezerra Gomes da Silva, Hazem Adel Ashmawi

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Postoperative Nausea and Vomiting (PONV) risk factors have not been defined for obstetric patients. In this study, our objective was to identify potential risk factors for PONV after cesarean sections performed under spinal anesthesia.


One cohort of patients submitted to cesarean under spinal anesthesia was used to investigate potential risk factors for PONV. The best numerical risk factors were dichotomized, using chi-squared method. A conditional independence (incremental association method) casual network was used to select the best predictors for PONV.


Two hundred and fifty of 260 patients remained in the study. Odds ratio for PONV of younger maternal age (< 25 years: 2.9 [1.49−5.96]), lower spinal bupivacaine dose (< 13 mg, inf [2.4-inf]), lower spinal morphine dose (< 80 mg, 0.03 [0−0.97]), history of motion sickness (2.5 [1.27−5.25]), significant nausea during the first trimester (0.3 [0.16−0.64]), intraoperative nausea and vomiting (8.2 [3.67−20.47]) and lower gestational age (< 38 weeks, 2.0 [1.01−4.08]) were statistically significant. The causal network selected absence of significant nausea during the first gestational trimester, intraoperative nausea, and gestational age < 38 weeks as the main direct risk factors for PONV.


Intraoperative nausea and maternal age < 25 years were the main risk factors for PONV after cesareans under spinal anesthesia. Absence of self-reported nausea during the first trimester was a protective factor for post-cesarean nausea and vomiting.


Postoperative nausea and vomiting,  Risk factors,  Cesarean section



Os fatores de risco para náusea e vômitos pós-operatórios (NVPO) ainda não foram definidos para pacientes de obstetrícia. Neste estudo, nosso objetivo foi identificar potenciais fatores de risco para NVPO após parto cesariano realizado sob raquianestesia.


Uma coorte de pacientes submetidas a cesariana sob raquianestesia foi usada para investigar potenciais fatores de risco para NVPO. Os melhores fatores de risco numéricos foram dicotomizados, através do método qui-quadrado. Uma rede casual de independência condicional (método de associação adicional) foi usada para selecionar os melhores preditores de NVPO.


Das 260 pacientes iniciais, 250 completaram o estudo. A razão de chances para NVPO foi estatisticamente significante para menor idade materna (< 25 anos: 2,9 [1,49−5,96]), dose mais baixa de bupivacaina raquidiana (< 13 mg, inf [2,4-inf]), dose mais baixa de morfina raquidiana (< 80 mg, 0,03 [0−0,97]), histórico de enjoo de movimento (2,5 [1,27−5,25]), náuseas importantes durante o primeiro trimestre (0,3 [0,16−0,64]), náusea e vômitos intraoperatórios (8,2 [3,67−20,47]) e menor idade gestacional (< 38 semanas, 2,0 [1,01−4,08]). A rede causal selecionou ausência de náuseas significativas durante o primeiro trimestre gestacional, náusea intraoperatória e idade gestacional < 38 semanas como os principais fatores de risco diretos para NVPO.


Náusea intraoperatória e idade materna < 25 anos foram os principais fatores de risco para NVPO após cesariana sob raquianestesia. A ausência de náusea auto referida durante o primeiro trimestre foi um fator protetor para náusea e vômitos após cesariana.


Náuseas e vômitos pós-operatórios,  Fatores de risco,  Parto cesariano


1 C.C. Apfel, K. Korttila, M. Abdalla, et al. An international multicenter protocol to assess the single and combined benefits of antiemetic interventions in a controlled clinical trial of a 2x2x2x2x2x2 factorial design (IMPACT) Control Clin Trials., 24 (2003), pp. 736-751

2 T.J. Gan, P. Diemunsch, A.S. Habib, et al. Consensus Guidelines for the Management of Postoperative Nausea and Vomiting Anesth Analg., 118 (2014), pp. 85-113

3 C.C. Apfel, E. Läärä, M. Koivuranta, C.A. Greim, N. Roewer A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers Anesthesiology., 91 (1999), pp. 693-700

4 D.H. Chestnut, C.A. Wong, L.C. Tsen, W.D. Kee, Y. Beilin, J. Mhyre Chestnut’s obstetric anesthesia: principles and practice e-book Elsevier Health Sciences (2014 Feb), p. 28

5 G.S. Collins, J.B. Reitsma, D.G. Altman, K.G.M. Moons Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement J Clin Epidemiol., 68 (2015), pp. 134-143

6 L.A.P. Yamada, G.M.N. Guimarães, M.A.S. Silva, A.M. Sousa, H.A. Ashmawi Development of a multivariable predictive model for postoperative nausea and vomiting after cancer surgery in adults Rev Bras Anestesiol., 69 (2019), pp. 342-349

7 M.J.P. Harnett, N. O’Rourke, M. Walsh, J.M. Carabuena, S. Segal Transdermal scopolamine for prevention of intrathecal morphine-induced nausea and vomiting after cesarean delivery Anesth Analg., 105 (2007), pp. 764-769

8 I. Tsamardinos, C.F. Aliferis, A.R. Statnikov, E. Statnikov Algorithms for large scale markov blanket discovery FLAIRS Conference (2001), pp. 376-381

9 Y. Benjamini, D. Yekutieli The control of the false discovery rate in multiple testing under dependency The Annals Statistics., 29 (2000), pp. 1165-1188

10 S.-A. Nortcliffe, J. Shah, D.J. Buggy Prevention of postoperative nausea and vomiting after spinal morphine for Caesarean section: comparison of cyclizine, dexamethasone and placebo Br J Anaesth., 90 (2003), pp. 665-670

11 C.C. Apfel, N. Roewer, K. Korttila How to study postoperative nausea and vomiting Acta Anaesthesiol Scand., 46 (2002), pp. 921-928

12 BM Mishriky, AS. Habib Nicotine for postoperative analgesia a systematic review and meta-analysis Anesth Analg., 119 (2014), pp. 268-275

13 R. Gadsby, A.M. Barnie-Adshead, C. Jagger Pregnancy nausea related to women’s obstetric and personal histories Gynecol Obstet Invest., 43 (1995), pp. 108-111

14 C. Louik, S. Hernandez-Diaz, M.M. Werler, A.A. Mitchell Nausea and vomiting in pregnancy: maternal characteristics and risk factors Paediatr Perinat Epidemiol., 20 (2006), pp. 270-278

15 JM. Brandes First-trimester nausea and vomiting as related to outcome of pregnancy Obstet Gynecol., 30 (1967), pp. 427-431

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