Measure ID

GA 03-OB: Percentage of cesarean delivery cases where general anesthesia was administered after epidural injection.

Measure Type
Available for Provider Feedback
No - Departmental Only
Not Applicable - Informational Only

General anesthesia is used in roughly 5% of elective cesarean deliveries and 14-20% of emergent cesarean deliveries.1,2 Mothers who receive neuraxial anesthesia report less pain on the day of surgery, show less gastrointestinal stasis, fevers, and coughing on post op day 2, and show earlier mobility and breastfeeding onset than those who receive general anesthesia.3  Mothers who receive general anesthesia during cesarean delivery may also be at increased risk of severe postpartum depression as compared to those who receive neuraxial anesthesia.4

Measure Time Period

Cesarean Delivery cases where only epidural anesthesia was used.

  • Cesarean delivery cases (determined by Obstetric Anesthesia Type value code: 2)
  • Cases with conversion to general anesthesia less than or equal to 75 minutes after delivery 
  • Cesarean Hysterectomies (determined by Obstetric Anesthesia Type value code: 4)
  • Cesarean delivery cases that use general anesthesia without epidural anesthesia
  • Non-cesarean delivery cases
  • Labor Epidurals (determined by Obstetric Anesthesia Type value codes: 0, 3, 5, 6, 8) 
  • Placenta Accreta cases using the following ICD-10 codes:
    • O43.2, O43.21, O43.22, and O43.22
    • O43.[211, 212, 213, 219, 221, 222, 223, 229, 231, 232, 233, 239]
Success Criteria

Cesarean delivery with epidural anesthesia completed without use of general anesthesia.

Other Measure Details
  • Use of general anesthesia is determined by Anesthesia Technique: General value codes >0.
  • GA-03: Use of epidural anesthesia is determined by Anesthesia Technique: Neuraxial value code: 2.
  • GA-03b: Use of Combined Spinal Epidural (CSE) is determined by Anesthesia Technique: Neuraxial value code: 1.
  • Cases converted to general anesthesia after delivery for reasons outside of pain management are meant to be excluded from these measures. If the earliest intubation time is greater than or equal to 75 minutes after delivery of neonate, the case will be excluded. 

Delivery of Neonate Date/Time algorithm:

  1. Delivery of neonate 2 (Concept ID: 50189)
  2. If not available, Neonate delivery (Concept ID: 50358).
  3. If not available, PACU Start

*This measure will include valid MPOG cases defined by the Is Valid Case phenotype.

Risk Adjustment

Not applicable.

Provider Attribution

Departmental only measure - not available for provider feedback emails.

MPOG Concept Used
MPOG Phenotypes Used
  1. Traynor, Andrea J., Meredith Aragon, Debashis Ghosh, Ray S. Choi, Colleen Dingmann, Zung Vu Tran, and Brenda A. Bucklin. 2016. “Obstetric Anesthesia Workforce Survey: A 30-Year Update.” Anesthesia and Analgesia 122 (6): 1939–46.
  2. Juang, Jeremy, Rodney A. Gabriel, Richard P. Dutton, Arvind Palanisamy, and Richard D. Urman. 2017. “Choice of Anesthesia for Cesarean Delivery: An Analysis of the National Anesthesia Clinical Outcomes Registry.” Anesthesia and Analgesia 124 (6): 1914–17.
  3. Morgan, B. M., J. M. Aulakh, J. P. Barker, P. W. Reginald, T. Goroszeniuk, and A. Trojanowski. 1984. “Anaesthetic Morbidity Following Caesarean Section under Epidural or General Anaesthesia.” The Lancet 1 (8372): 328–30.
  4. Guglielminotti, Jean, and Guohua Li. 2020. “Exposure to General Anesthesia for Cesarean Delivery and Odds of Severe Postpartum Depression Requiring Hospitalization.” Anesthesia and Analgesia 131 (5): 1421–29.
Measure Authors
 Measure Author  Institution
 Nicole Barrios, MHA, RN  University of Michigan
 Monica Servin, MD  University of Michigan
 Kate Buehler, MS, RN  University of Michigan
 Nirav Shah, MD  University of Michigan
 Rob Coleman  University of Michigan
 MPOG OB Subcommittee  


Measure Reviewer(s)

Next Review: 2026

 Date Reviewed




 OB Subcommittee   Vote                          







Published Date: 2023






 Exclude OBAT enumeration 2



 Exclude Placenta Accreta cases   using ICD-10 codes.



 Initial publication