Effect of anaesthetic technique on neonatal morbidity in emergency caesarean section for foetal distress

Abstract

BackgroundWhile foetal distress is typically associated with ischaemic injury, few studies have assessed neonatal morbidity for emergency caesarean section. Moreover, the decision of the anaesthetic technique may be of paramount importance in emergency caesareans, because of the limited time and increased risk. We aimed to evaluate the effect of the anaesthetic technique on neonatal morbidity in emergency caesarean indicated for foetal distress.MethodsThis was a single-centre, prospective observational study, conducted between July-2015 and December-2015. The study enrolled parturient with indication for emergency caesarean section after diagnosis of foetal distress, who received either regional or general anaesthesia. The outcome measures were: 1, 5-minute Apgar scores; umbilical blood pH; length of hospitalization; and morbidity, defined as a 5-minute Apgar score <7, need for mechanical ventilation, admittance to a neonatal intensive care unit, or respiratory insufficiency symptoms.Results61 patients were included in the study, of whom 31 received regional anaesthesia. Neonatal morbidity was noted in 5 and 9 cases with regional and general anaesthesia, respectively. The 1-minute Apgar score was significantly lower(p = 0,045) for cases with general anaesthesia, which was not true for the 5-minute Apgar score. Regional anaesthesia was non-significantly associated with shorter length of hospitalization, lower incidence of morbidity, and higher umbilical blood pH. When we take regional anaesthesia cases as a reference point, we detected that general anaesthesia cases are showing 2,2 times more morbidity risk. But these results did not reach any statistically significant levels.ConclusionsWhile we did find some improved results for regional anaesthesia group, we found no statistical evidence that neither anaesthesia technique is superior regarding neonatal morbidity. We think that regional anaesthesia should be preferred whenever possible because of our improved results of length of hospital stay, APGAR and morbidity and we think that general anaesthesia is indicated for very urgent cases or regional anaesthesia contraindicated patients.Trial registrationhttp://www.isrctn.com/ISRCTN15181117

General Versus Regional Anaesthesia for Caesarean Section Indicated for Acute Foetal Distress: A Retrospective Cohort Study

“…Our ndings are consistent with those of several other studies in Africa, Europe and the USA, where GA was seen to be associated with lower APGAR scores, following anaesthesia for AFD. However, unlike our study, their results showed that lower APGAR scores following GA was signi cant even at the 5 th minute following delivery (15), (16), (17). GA is shown in our study to be associated with signi cantly higher chances of neonatal resuscitation when compared to SA.…”

Moderate rate of implementation of spinal anesthesia for cesarean section: does it improve neonatal well-being? A case–control study

“…In contrast, it has been reported that the “traditional” low APS defined as < 7 remains relevant for the prediction of neonatal adverse outcomes 10 , 11 . Some significant studies showed that APS at 5 min was a prognostic factor of neonatal adverse outcomes 2 , 10 , 12 and indeed chose APS at 5 min as a measure to evaluate neonatal outcomes 5 , 13 . In a joint statement issued by the Japan Society of Obstetrics and Gynecology and the Japan Association of Obstetricians and Gynecologists, neonatal asphyxia was defined as a case with 5-min APS of < 7.…”

“…In an analysis of the data for 113,300 preterm infants from the Swedish Medical Birth Register, APS at 5 and 10 min provided prognostic information about neonatal survival 12 . In a prospective study investigating the effect of anesthetic technique (GA vs. SA) on neonatal morbidity in emergency CS for fetal distress, the neonatal morbidity was defined as a 5-min APS < 7, need for mechanical ventilation, admittance to a neonatal intensive care unit, or respiratory insufficiency symptoms 13 .…”

How does the obstetric anesthesia in cesarean section affect the wellbeing of the newborn?

“…This may be because of hypotension following RA that can decrease uteroplacental perfusion and produce fetal acidosis [6,15,16], although in some studies, GA was associated with lower pH values [17,18]. Edipoglu et al [19] found that umbilical blood pH with GA is associated with lower pH values (7.20 for GA versus 7.29 for RA), although this difference was not statistically significant (p > 0.05). In our study, we also did not find a statistically significant difference in umbilical cord pH, and base excess (all p>0.05) [GA -pH:7.36 (6.72-7.53) versus RA pH: 7.35 (7.04-7.56) ].…”