Ultrasound Estimates for Midline Epidural Punctures in the Obese Parturient
Why this work is in the frame
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Bibliographic record
Abstract
BACKGROUND: Spinal ultrasound (US) in the transverse median (TM) plane underestimates the distance to the epidural space in obese pregnant women, most likely because of compression of the subcutaneous tissue during the assessment, often required to compensate for poor visibility. We tested whether scanning in the paramedian sagittal oblique (PSO) plane compared with the TM plane resulted in a more precise estimate of the actual skin-epidural space measurement in this population. METHODS: We recruited obese (World Health Organization classes I, II, and III) pregnant women at term requesting labor epidural analgesia or combined spinal-epidural anesthesia for cesarean delivery. US imaging was performed with a 5-2 MHz curved array probe to identify the insertion point and to estimate the distance from the skin to the epidural space (US-estimated depth, UD) in the PSO and TM planes. The measurements were performed with the least possible compression of the subcutaneous tissue by the US probe. All punctures were performed via the midline approach. An anesthesiologist performed the epidural/combined spinal-epidural procedure at the predetermined insertion point, and marked the actual needle distance from the skin to the epidural space (needle depth, ND). Bland-Altman analysis was used to determine the differences and 95% limits of agreement between US depth and ND. RESULTS: We studied 60 women. The mean (SD) body mass index was 39.6 (7.9) kg/m(2) (range 30.4-66.2 kg/m(2)). The US estimate in the PSO and TM planes, and the actual ND were 6.5 (1.2) cm, 6.5 (1.1) cm, and 6.6 (1.3) cm, respectively. The Bland-Altman analysis showed a mean difference of 0.05 cm and 95% limits of agreement of ±1 cm. The quality of imaging was rated as good in the PSO and TM planes in 86.7% and 68.3%, respectively (P = 0.028). CONCLUSION: The estimates of the US-determined distance to the epidural space in the PSO are comparable to those in the TM plane. The ability to use both estimates interchangeably for midline punctures may prove useful in patients presenting with poor visibility in the TM plane.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it