Maternal and Fetal Catecholamines and Uterine Incision-to-Delivery Interval During Elective Cesarean Section

Bader, Angela M.; Datta, Sanjay; Arthur, G. R.; Benvenuti, Elena; Courtney, Marie; Hauch, M A; Smith, Bradley E.

doi:10.1097/00132582-199101000-00039

Cited by 14 publications

(15 citation statements)

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“…In our study, decreased UA pH was also predicted by maximum decrease in SAP and U–D time. Previous studies have also shown that prolonged U–D times were associated with fetal acidosis [18, 19]. These findings can be explained by the perfusion‐pressure‐dependent nature of uteroplacental blood flow and by the interruption of perfusion that occurs after uterine incision.…”

Section: Discussionmentioning

confidence: 87%

Multivariate analysis of factors associated with umbilical arterial pH and standard base excess after Caesarean section under spinal anaesthesia*

Kee

Lee

2003

Anaesthesia

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SummaryWe have investigated the factors predicting umbilical arterial pH (UA pH) and standard base excess (UA BE) in 337 consecutive elective Caesarean sections performed under spinal anaesthesia. Multiple linear regression analysis was performed with UA pH and UA BE as the dependent factors. We found that the significant factors predicting UA pH were: use of ephedrine, uterine incision-to-delivery time, maximum decrease in systolic arterial pressure and the interaction between ephedrine use and duration of hypotension (adjusted R 2 ¼ 0.39, F 15,321 ¼ 15.4, p < 0.0001). The significant factors predicting UA BE were: use of ephedrine and the interaction between ephedrine use and duration of hypotension (adjusted R 2 ¼ 0.52, F 15,321 ¼ 25.0, p < 0.0001). We conclude that, in order to minimise the risk of fetal acidosis, ephedrine should not be used before delivery, uterine incision-to-delivery time should be as short as possible, and alpha-agonists such as metaraminol or phenylephrine should be used to minimise both the magnitude and duration of hypotension.

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Section: Discussionmentioning

confidence: 87%

Multivariate analysis of factors associated with umbilical arterial pH and standard base excess after Caesarean section under spinal anaesthesia*

Kee

Lee

2003

Anaesthesia

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“…Bader et al [11] suggested that with longer uterine incision-delivery intervals umbilical arterial norepinephrine concentrations were increased and umbilical arterial pH was decreased. Exceeding uterine incision-delivery interval more than 180 s would result in fetal acidosis.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Neonatal Effects of Epidural and General Anesthesia for Cesarean Section

Şener¹,

Güldoğuş²,

Karakaya³

et al. 2003

Gynecol Obstet Invest

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We assessed the influence of anesthetic technique for cesarean section on neonatal outcome. Thirty parturient women (ASA I/II) were randomly allocated into two groups. In Group GA general anesthesia was induced with 4 mg·kg^–1 thiopental and 1.5 mg·kg^–1 succinylcholine. In group EA epidural anesthesia was performed with 20 ml 0.375% bupivacaine through L_3–4 inter-space. 1-min Apgar scores were significantly higher in group EA (p < 0.001). Neurologic and Adaptive Capacity scores at 2 and 24 h were higher in group EA (p < 0.001). In terms of blood gas values, umbilical arterial pH and pO₂ values were higher in group EA (p < 0.05 and p < 0.001, respectively). The first breast-feeding intervals were found to be shorter in group EA (p < 0.001). We conclude that in terms of better Apgar and NAC scores, acid-base status and earlier initiation of breast-feeding, the epidural anesthesia may be preferred to general anesthesia in cesarean section.

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“…Previous investigations have largely focused on women in labor, and the time interval from decision to perform cesarean to skin incision, or the interval from uterine incision to delivery, and the relationship to neonatal morbidity. 8, 10, 14 Few studies have examined the role of the time interval from skin incision to delivery on neonatal outcomes, and no prior studies have examined the effect of BMI on this interval. 9, 10 In addition, results of all studies evaluating incision to delivery interval on neonatal outcomes are confounded by indication; surgery tends to be appropriately performed faster in fetuses suspected to be at risk, likely improving outcomes to levels comparable to fetuses considered to be at low risk in whom surgery is slower.…”

Section: Commentmentioning

confidence: 99%

Impact of obesity on incision-to-delivery interval and neonatal outcomes at cesarean delivery

Conner

Tuuli

Longman

et al. 2013

American Journal of Obstetrics and Gynecology

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OBJECTIVE To test the hypothesis that increasing body mass index (BMI) is associated with increased time from skin incision to infant delivery and increased neonatal morbidity at cesarean. STUDY DESIGN We performed a retrospective cohort study of all cesarean deliveries occurring at one institution from 2004-2008. Four comparison groups were defined by body mass index (BMI) <30 kg/cm2 (n=668), 30-39.9 (n=1002), 40-49.9 (n=403), or ≥50 (n=193). The primary outcome was time from skin incision to infant delivery. Secondary outcomes were a composite measure of neonatal morbidity and its individual components: 5-minute Apgar score less than 7, umbilical cord arterial pH <7.10 and <7.20, umbilical cord arterial base excess <-8 (mmol/L), Special Care Nursery (SCN) admission, and NICU admission. RESULTS Increasing BMI was associated with significantly increased time from skin incision to infant delivery, demonstrating a dose response pattern. Minutes from skin incision to delivery of the infant by BMI strata were; 9.4 ± 5.9 for BMI <30, 11.0 ± 6.8 for BMI 30-39.9, 13.0 ± 8.0 for BMI 40-49.9, and 16.0 ± 11.3 for BMI ≥50 (p < 0.01). Composite neonatal morbidity was significantly higher with increasing BMI; 23.0% for BMI <30, 25% for BMI 30-39.9, 29.8% for BMI 40-49.9, and 32.1% for BMI ≥ 50 (p=0.02). CONCLUSION Increasing BMI is associated with a significantly increased time from skin incision to infant delivery and neonatal morbidity. Cesarean technique remains to be optimized for obese women.

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Maternal and Fetal Catecholamines and Uterine Incision-to-Delivery Interval During Elective Cesarean Section

Cited by 14 publications

References 0 publications

Multivariate analysis of factors associated with umbilical arterial pH and standard base excess after Caesarean section under spinal anaesthesia*

Multivariate analysis of factors associated with umbilical arterial pH and standard base excess after Caesarean section under spinal anaesthesia*

Comparison of Neonatal Effects of Epidural and General Anesthesia for Cesarean Section

Impact of obesity on incision-to-delivery interval and neonatal outcomes at cesarean delivery

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