The effect of spinal hypotension and anesthesia-to-delivery time interval on neonatal outcomes in planned cesarean delivery

Knigin, David; Avidan, Alexander; Weiniger, Carolyn F.

doi:10.1016/j.ajog.2020.08.005

Cited by 29 publications

(24 citation statements)

References 19 publications

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“…The pre-delivery hypotension rate in this study was 74.6 % (n=261), higher than as reported by Anusorntanawat 18 and Knigin et al 19 . The higher rate of predelivery hypotension in this study could be due to the differences in definition.…”

Section: Rate Of Hypotensioncontrasting

confidence: 61%

Pre-delivery hypotension after spinal anesthesia during cesarean section and its associated factors at Jigme Dorji Wangchuck National Referral Hospital, Bhutan

Yoezer

Tenzin²,

Tshering³

et al. 2021

Bhutan Health Journal

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Introduction: The current choice of anesthesia for the cesarean section is spinal anesthesia. However, hypotension is the major complication. If promptly not recognized and treated, it increases the morbidity and mortality of the mother and fetus. This study was conducted to evaluate the rate of pre-delivery hypotension and risk factors following spinal anesthesia for cesarean section at the National Referral Hospital in Bhutan. Methods: A cohort study was conducted from 1st October 2018 to 30th June 2019 on 350 women undergoing cesarean section under spinal anesthesia. Pre-delivery hypotension was defined as systolic blood pressure < 100 mm Hg. The association of factors for hypotension was tested using multivariable binary logistic regression using a forward stepwise model. A p-value < 0.05 was considered significant. Results: The rate of pre-delivery hypotension was 74.6 % (n=261). History of hypertension during pregnancy (Adjusted OR 0.25, [0.11-0.60], p=0.013), prophylaxis use of ephedrine (Adjusted OR 0.45, [0.22-0.92], p= 0.024) and ondansetron (Adjusted OR 0.43, [0.22-0.82], p= 0.010),longer preoperative fasting duration (Adjusted OR 1.12, [1.01-1.21], p=0.024,), sensory block level <= T4 (Adjusted OR 3.4, [1.8-6.4], p=<0.001) and baseline systolic blood pressure less than or equal to 120 mmHg (Adjusted OR 2.8, [1.5-5.1], p=0.001) were significant risk factors. Conclusions: This study conduces that the rate of pre-delivery hypotension following spinal anesthesia in a cesarean section was high among women undergoing cesarean section. It is alarming as around two-third of women and fetus undergoing cesarean section under spinal anesthesia are at risk of consequences of hypotension. Most of the risk factors in the study are modifiable. The study suggests that if the anesthesia provider intervenes in managing the modifiable risk factors and treat hypotension promptly, it can help reduce the risk of women and fetus to spinal hypotension consequences.

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Section: Rate Of Hypotensioncontrasting

confidence: 61%

Pre-delivery hypotension after spinal anesthesia during cesarean section and its associated factors at Jigme Dorji Wangchuck National Referral Hospital, Bhutan

Yoezer

Tenzin²,

Tshering³

et al. 2021

Bhutan Health Journal

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“…In their study for epidural anesthesia, comparing ropivacaine and bupivacaine effects for scheduled CS, Sandra Kampe et al [27] found some cases of neonates with Apgar score less than 7. A study on SA with bupivacaine [47] showed an acidosis rate in neonates of 3.4%.…”

Section: Discussionmentioning

confidence: 99%

“…Our results are similar to those of Chantal T. Crochetière and coworkers [32] . Other researchers have considered abnormal Apgar score or acidosis with Apgar score < 7 [27,38,47,48] . In their study for epidural anesthesia, comparing ropivacaine and bupivacaine effects for scheduled CS, Sandra Kampe et al [27] found some cases of neonates with Apgar score less than 7.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Hypotension and Associated-risk Factors in Epidural Anesthesia With 2% Lidocaine and Epinephrine During Elective Cesarean Section, Efficacy and Safety Assessment

2021

GJACR

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Background: Cesarean section is a worldwide common surgery that requires anesthetic techniques. Many local anesthetics are being now used, but are associated with, dose- dependent and at different level, some side effects including toxicity. Hypotension was described as the first and threat side effect associated to neuraxial techniques. Despite many preventive strategies, it continues to challenge anesthesia providers around the world. Lidocaine was found to be less toxic compared with others commonly used and has been recommended for anesthesia procedures requiring large dose of local anesthetic including epidural anesthesia. The main purpose of this research was to determine the incidence of hypotension and identify the possible risk factors associated with it and thus, assess the efficacy and safety when lidocaine is applied together with epinephrine, in epidural anesthesia for elective cesarean delivery. Materials and methods: This retrospective observational institutional-based study, recruited 612 parturients who underwent elective cesarean section under epidural anesthesia with 2% lidocaine and 1/200000 epinephrine, at 1st affiliated hospital of Chongqing Medical University in 2019. Exclusion criteria included any contraindication to elective cesarean section delivery, general anesthesia, baseline systolic blood pressure < 100mmh and > 140 mm hg, gestational age < 37 weeks and > 42 weeks etc. SPSS 26.0 version and different appropriated tests were used for statistical analysis. P value < 0.05 was accepted as statistically significant. Results: The hypotension incidence was 13.2%, and identified factors associated with it were Baseline Systolic Blood Pressure < 120mmhg, gestational age < 40 weeks, maternal body weight ≤ 60 kg and duration of cesarean delivery (surgery) > 45 minutes. Conclusion: The variables in correlation with increased hypotension rate are baseline systolic blood pressure, gestational age, maternal weight, and surgery duration. 2%Lidocaine with epinephrine as adjuvant presented best outcomes towards both mother and neonates, was therefore efficacy and safe under the anesthetic conditions of our study.

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“…This may be attributed to the increased demand for instrumental and surgical deliveries of CH infants. Spinal anesthesia may result in sustained spinal hypotension with the complication of neonatal acidosis 23 . It could be assumed that the acid-base compromise would contribute to the development of transient CH, however, the type of anesthesia did not differ between our transient and permanent CH infants nor was it identified as a predictive factor for transient CH.…”

Section: Discussionmentioning

confidence: 99%

Congenital Hypothyroidism Can Dictate the Mode of Delivery and Intra-labor Medication Usage

Rosen

Lavie

Yackobovitch‐Gavan

et al. 2021

Preprint

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Pregnancy and parturition reflect the complex interaction between physiologic conditions of the mother and her offspring, and fetal health characteristics may affect maternal health throughout pregnancy and delivery. We investigated the characteristics of the mother-infant dyad of term infants detected by the National Newborn Screening Program as having congenital hypothyroidism (CH) (131 out of 108,717; 0.12%). Three years of surveillance in our Pediatric Endocrine Clinic revealed that 65 had transient CH and 66 had permanent CH. A higher proportion of deliveries of CH infants required vacuum assistance, and more infants with CH were born through a cesarean section compared to the general population (p<0.001). Medication during labor also differed, with higher rates of oxytocin (p<0.001) and antibiotics (p=0.008) administered to mothers of CH infants. A multivariate logistic regression model revealed an increased demand for oxytocin administration during the labor of a CH infant in a hypothyroidism severity-dependent manner, expressed as a threefold risk associated with permanent but not transient CH. Our findings of increased utilization of medical interventions during the labor and delivery of CH infants suggest that the prenatal fetal thyroid function affects the development and progress of labor and delivery, in response to oxytocin.

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The effect of spinal hypotension and anesthesia-to-delivery time interval on neonatal outcomes in planned cesarean delivery

Cited by 29 publications

References 19 publications

Pre-delivery hypotension after spinal anesthesia during cesarean section and its associated factors at Jigme Dorji Wangchuck National Referral Hospital, Bhutan

Pre-delivery hypotension after spinal anesthesia during cesarean section and its associated factors at Jigme Dorji Wangchuck National Referral Hospital, Bhutan

Incidence of Hypotension and Associated-risk Factors in Epidural Anesthesia With 2% Lidocaine and Epinephrine During Elective Cesarean Section, Efficacy and Safety Assessment

Congenital Hypothyroidism Can Dictate the Mode of Delivery and Intra-labor Medication Usage

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