Abdominal girth has a strong correlation with ultrasound-estimated epidural depth in parturients: a prospective observational study

  • Mehmet CanturkEmail author
  • Fusun Karbancioglu Canturk
  • Nazan Kocaoglu
  • Meltem Hakki
Original Article



Preprocedural ultrasound examination of vertebral column guides to locate desired intervertebral space and provides a prevision of needle trajectory and estimated needle depth in parturients. The objective of this study was to assess the correlation between ultrasound-estimated epidural depth (ED) with abdominal girth (AG), body mass index (BMI), weight, height, and age.


In this prospective, observational study, ultrasound imaging was done at L3–4 interspace in transverse median plane (TP) and paramedian sagittal oblique plane (PSO) to obtain ultrasound estimates of skin to epidural space depth. Combined spinal epidural anesthesia was performed at L3–4 interspace. AG, BMI, age, height, and weight were recorded for every parturient.


Data from 130 parturients were analyzed. Estimated ED was 56.5 ± 9.5 mm in TP, 57.5 ± 9.3 mm in PSO, and actual epidural depth was 57.9 ± 9.4 mm. Correlation coefficients between ED and AG were 0.797 in TP (95% CI 0.727–0.854, p < 0.001) and 0.803 in PSO (95% CI 0.733–0.857, p < 0.001). Correlation coefficients between ED and BMI were 0.543 in TP (95% CI 0.405–0.661, p < 0.001) and 0.566 in PSO (95% CI 0.428–0.680, p < 0.001). Correlation coefficients between ED and weight were 0.593 in TP (CI = 0.466–0.695, p < 0.001) and 0.615 in PSO (CI = 0.500–0.716, p < 0.001). Height and age had no significant correlation with ED.


Abdominal girth has a strong correlation with ultrasound-estimated epidural depth in parturients.


Abdominal girth BMI Weight Epidural Ultrasound 



The hospital supplied ultrasound device. The authors supplied financial support for the study.

Author contributions

MC: project design, data collection, statistical analysis, and writing manuscript. FKC: data collection, supervision, writing, and final manuscript check. NK: data collection and statistical analysis. MH: data collection and final manuscript check.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


  1. 1.
    Bassiakou E, Valsamidis D, Loukeri A, Karathanos A. The distance from the skin to the epidural and subarachnoid spaces in parturients scheduled for caesarean section. Minerva Anestesiol. 2011;77:154–59.Google Scholar
  2. 2.
    Brownridge P. Epidural and subarachnoid analgesia for elective caesarean section. Anaesthesia. 1981;36:70.CrossRefGoogle Scholar
  3. 3.
    Coates MB. Combined subarachnoid and epidural techniques. Anaesthesia. 1982;37:89–90.CrossRefGoogle Scholar
  4. 4.
    Birnbach DJ, Soens MA. Hotly debated topics in obstetric anesthesiology 2008: a theory of relativity. Minerva Anestesiol. 2008;74:409–24.Google Scholar
  5. 5.
    Fun W, Lew E, Sia AT. Advances in neuraxial blocks for labor analgesia: new techniques, new systems. Minerva Anestesiol. 2008;74:77–85.Google Scholar
  6. 6.
    Shibli KU, Russell IF. A survey of anaesthetic techniques used for caesarean section in the UK in 1997. Int J Obstet Anesth. 2000;9:160–67.CrossRefGoogle Scholar
  7. 7.
    Cook TM. Combined spinal-epidural techniques. Anaesthesia. 2000;55:42–64.CrossRefGoogle Scholar
  8. 8.
    Hirabayashi Y, Shimizu R, Fukuda H, Saitoh K, Igarashi T. Effects of the pregnant uterus on the extradural venous plexus in the supine and lateral positions, as determined by magnetic resonance imaging. Br J Anaesth. 1997;78:317–9.CrossRefGoogle Scholar
  9. 9.
    Keplinger M, Marhofer P, Eppel W, Macholz F, Hachemian N, Karmakar MK, Marhofer D, Klug W, Kettner SC. Lumbar neuraxial anatomical changes throughout pregnancy: a longitudinal study using serial ultrasound scans. Anaesthesia. 2016;71:669–74.CrossRefGoogle Scholar
  10. 10.
    Ravi KK, Kaul TK, Kathuria S, Gupta S, Khurana S. Distance from skin to epidural space: correlation with body mass index (BMI). J Anaesthesiol Clin Pharmacol. 2011;27:39–42.Google Scholar
  11. 11.
    Arzola C, Davies S, Rofaeel A, Carvalho JC. Ultrasound using the transverse approach to the lumbar spine provides reliable landmarks for labor epidurals. Anesth Analg. 2007;104:1188–92.CrossRefGoogle Scholar
  12. 12.
    Grau T, Leipold RW, Conradi R, Martin E, Motsch J. Efficacy of ultrasound imaging in obstetric epidural anesthesia. J Clin Anesth. 2002;14:169–75.CrossRefGoogle Scholar
  13. 13.
    Grau T, Leipold RW, Horter J, Conradi R, Martin E, Motsch J. The lumbar epidural space in pregnancy: visualization by ultrasonography. Br J Anaesth. 2001;86:798–804.CrossRefGoogle Scholar
  14. 14.
    Helayel PE, da Conceicao DB, Meurer G, Swarovsky C, de Oliveira Filho GR. Evaluating the depth of the epidural space with the use of ultrasound. Rev Bras Anestesiol. 2010;60:376–82.CrossRefGoogle Scholar
  15. 15.
    Seligman KM, Weiniger CF, Carvalho B. The accuracy of a handheld ultrasound device for neuraxial depth and landmark assessment: a prospective cohort trial. Anesth Analg. 2018;126:1995–8.CrossRefGoogle Scholar
  16. 16.
    Chong SY, Chong LA, Ariffin H. Accurate prediction of the needle depth required for successful lumbar puncture. Am J Emerg Med. 2010;28:603–6.CrossRefGoogle Scholar
  17. 17.
    Clinkscales CP, Greenfield ML, Vanarase M, Polley LS. An observational study of the relationship between lumbar epidural space depth and body mass index in Michigan parturients. Int J Obstet Anesth. 2007;16:323–7.CrossRefGoogle Scholar
  18. 18.
    Razavizadeh MR, Fazel MR, Mosavi M, Sehat M. The relationship between patients’ anthropometric characteristics and depth of spinal needle insertion. Anesth Pain Med. 2016;6:e24993.CrossRefGoogle Scholar
  19. 19.
    Sharma V, Swinson AK, Hughes C, Mokashi S, Russell R. Effect of ethnicity and body mass index on the distance from skin to lumbar epidural space in parturients. Anaesthesia. 2011;66:907–12.CrossRefGoogle Scholar
  20. 20.
    Singh S, Wirth KM, Phelps AL, Badve MH, Shah TH, Sah N, Vallejo MC. Epidural catheter placement in morbidly obese parturients with the use of an epidural depth equation prior to ultrasound visualization. Sci World J. 2013;2013:695209.Google Scholar
  21. 21.
    Stamatakis E, Moka E, Siafaka I, Argyra E, Vadalouca A. Prediction of the distance from the skin to the lumbar epidural space in the Greek population, using mathematical models. Pain Pract. 2005;5:125–34.CrossRefGoogle Scholar
  22. 22.
    Watts RW. The influence of obesity on the relationship between body mass index and the distance to the epidural space from the skin. Anaesth Intensive Care. 1993;21:309–10.Google Scholar
  23. 23.
    Kinoshita T, Itoh M. Longitudinal variance of fat mass deposition during pregnancy evaluated by ultrasonography: the ratio of visceral fat to subcutaneous fat in the abdomen. Gynecol Obstet Invest. 2006;61:115–8.CrossRefGoogle Scholar
  24. 24.
    Grau T, Bartusseck E, Conradi R, Martin E, Motsch J. Ultrasound imaging improves learning curves in obstetric epidural anesthesia: a preliminary study. Can J Anaesth. 2003;50:1047–50.CrossRefGoogle Scholar
  25. 25.
    Sahota JS, Carvalho JC, Balki M, Fanning N, Arzola C. Ultrasound estimates for midline epidural punctures in the obese parturient: paramedian sagittal oblique is comparable to transverse median plane. Anesth Analg. 2013;116:829–35.CrossRefGoogle Scholar
  26. 26.
    Abe KK, Yamamoto LG, Itoman EM, Nakasone TA, Kanayama SK. Lumbar puncture needle length determination. Am J Emerg Med. 2005;23:742–6.CrossRefGoogle Scholar
  27. 27.
    Bonadio WA, Smith DS, Metrou M, Dewitz B. Estimating lumbar-puncture depth in children. N Engl J Med. 1988;319:952–3.CrossRefGoogle Scholar
  28. 28.
    Craig F, Stroobant J, Winrow A, Davies H. Depth of insertion of a lumbar puncture needle. Arch Dis Child. 1997;77:450.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2019

Authors and Affiliations

  1. 1.Department of Anesthesiology and ReanimationAhi Evran University Training and Research HospitalKırşehirTurkey
  2. 2.Department of Obstetrics and GynecologyAhi Evran University Training and Research HospitalKırşehirTurkey

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