Time From Neuraxial Anesthesia Placement to Delivery is Inversely Proportional to Umbilical Arterial Cord pH at Scheduled Cesarean Delivery

Rimsza, Rebecca R.; Perez, William M.; Babbar, Shilpa; O’Brien, Megan; Vricella, Laura K.

doi:10.1097/01.aoa.0000652952.24035.d4

Cited by 6 publications

(18 citation statements)

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“…There is a link between the drop of maternal blood pressure (BP) and fetal acidosis [ 3 ]. Yet, the impact of the duration of hypotension episodes is not well investigated.…”

Section: Introductionmentioning

confidence: 99%

Impact of interval between induction of spinal anesthesia to delivery on umbilical arterial cord ph of neonates delivered by elective cesarean section

Hassanin

El-Shahawy

Hussain

et al. 2022

BMC Pregnancy Childbirth

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Background To evaluate the impact of interval between induction of spinal anesthesia to delivery of the fetus by elective cesarean section on umbilical arterial pH and neonatal outcome. Patients and methods Two hundred and twenty pregnant women who were planned for elective cesarean section at term under spinal anesthesia were recruited. Minimum systolic, diastolic and mean arterial blood pressures (SBP, DBP, MAP) and largest pressure decrease (SBP, DBP, MPA) were also recorded. Induction of spinal anesthesia to delivery interval was measured. Following delivery, umbilical arterial cord analysis for pH and base deficit were done. Apgar scores at 1 min and at 5 min, neonatal intensive care unit (NICU) admission, need for mechanical ventilation and incidence of hypoxemic-ischemic encephalopathy were recorded. Results Induction of spinal anesthesia to delivery interval was 25.7 ± 5.6 min. Lowest SBP and MAP reached during cesarean delivery were 88.9 ± 7.3 mmHg and 60.4 ± 5.6 mmHg, respectively. MAP < 65 mmHg was reached in 136 (62%) patients with a decrease of MAP of > 20% in 149 (68%) patients. Duration of the longest hypotension episode was 3.3 ± 2.2 min. All patients required ephedrine administration for hypotensive episodes with an average dosage of 11.4 ± 3.2 mg. Umbilical pH of 7.3 ± 0.1 and base deficit of 8.3 ± 4.4 mmol/l were recorded. Apgar scores at 5 min were 8.5 ± 1.2. Eight (3.6%) neonates were admitted in the NICU. One neonate needed mechanical ventilation. There were no cases of hypoxemic-ischemic encephalopathy. There were inverse correlations between induction of spinal anesthesia to delivery interval, body mass index (BMI) and duration of longest hypotension episode in relation to umbilical pH (r = -0.817, -0.395 and -0.268, respectively). Cut off value for induction of spinal anesthesia to delivery interval greater than 27 min predicted an umbilical pH of < 7.2. Cut off value for the duration of the longest hypotension episode greater than 5 min predicted an umbilical pH of < 7.2. Cut off value for BMI greater than 35 kg/m2 predicted an umbilical pH of < 7.2. Conclusion Prolonged interval between induction of spinal anesthesia to delivery could be associated with neonatal acidosis. This could be aggravated by maternal obesity and prolonged duration of hypotension episodes during cesarean delivery.

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“…There is a link between the drop of maternal blood pressure (BP) and fetal acidosis [ 3 ]. Yet, the impact of the duration of hypotension episodes is not well investigated.…”

Section: Introductionmentioning

confidence: 99%

Impact of interval between induction of spinal anesthesia to delivery on umbilical arterial cord ph of neonates delivered by elective cesarean section

Hassanin

El-Shahawy

Hussain

et al. 2022

BMC Pregnancy Childbirth

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“…In their 2019 study, Rimsza et al [28] reported that longer spinal anesthesia to delivery time and uterine incision to delivery time were associated with decreased umbilical arterial pH in planned term cesarean deliveries. Eff orts to minimize predelivery time following spinal anesthesia injection could reduce the frequency of unanticipated neonatal acidemia.…”

Section: Issn: 2640-5628mentioning

confidence: 99%

Untitled

2019

Am J Anesth Clin Res

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Introduction: Though there are many studies on the eff ects of anesthesia methods used for cesarean section on the newborn, research on this topic still continues. In our prospective observational study, we investigated the eff ects of diff erent anesthesia techniques used in routine cesarean deliveries on early neonatal outcomes in our hospital. Methods: This prospective, observational, randomized study included a total of 222 ASA II risk group pregnant women undergoing elective cesarean section at term (38-41 weeks' gestation) without fetal distress. The women were randomized into three groups. In the general anesthesia with propofol group (Group P, n = 74), anesthesia was induced with 2 mg•kg -1 propofol and 0.6-0.9 mg•kg -1 rocuronium. In the general anesthesia with thiopental sodium group (Group T, n = 74), anesthesia was induced with 5 mg•kg -1 thiopental sodium and 0.6-0.9 mg•kg -1 rocuronium. Women in the spinal anesthesia group (Group SA, n = 74) were administered 0.5% (10 mg) hypertonic bupivacaine and 10 mcg fentanyl.Results: There were no signifi cant diff erences between Group SA, Group P, and Group T in terms of delivery time; neonatal 1-and 5-min Apgar scores; neonatal jaundice rates; neonatal systolic, diastolic, or mean blood pressure or peak heart rate; neonatal intensive care requirement; pH, PCO 2 , PO 2 values in cord blood gas; or neonatal glucose and lactate values. The rate of ephedrine use was signifi cantly higher in Group SA than in Group P and Group T. Maternal satisfaction score was higher in Group SA at postoperative 4 hours and in Group P at 24 hours. The number of newborns taken into intensive care unit in Group T was signifi cantly higher in the 1st hour, 4th hour, 5th hour and total. Respectively p value (0.006, 0,048, 0,048, and 0,005). Conclusion:None of the three anesthesia methods showed superiority after elective cesarean delivery. However, spinal anesthesia and general anesthesia with propofol are more appropriate for pregnant women in terms of eff ects on the neonate.

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“…Neonatal morbidity, including low 5-minute Apgar scores (<7), umbilical cord arterial pH < 7.2, base excess ≤8 mmol/L, and neonatal intensive care unit admissions are seen more often in obese women who undergo cesarean delivery. Hypotension during spinal anesthesia, and prolonged puncture time for regional anesthesia is more pronounced in obese women, and has been shown to cause lower umbilical cord pH in obese women undergoing scheduled cesarean delivery [40,41]. Women who are super-obese at the time of delivery have a 20% chance of neonatal intensive care unit admission [26].…”

Section: Neonatal Outcomesmentioning

confidence: 99%

“…Still, dose reductions for spinal anesthesia have not been proven beneficial in obese patients [54]. The obese patient is at risk for a higher number of punctures at time of spinal placement, simply due to spinal cord distance from skin [41,55]. Ultrasound guided regional anesthesia placement has been shown to reduce number of punctures in obese women [56].…”

Section: Anesthetic Considerationsmentioning

confidence: 99%

Obesity: Unique Challenges at the Time of Cesarean Delivery

Roloff¹,

Cao²,

Okekpe³

et al. 2020

Recent Advances in Cesarean Delivery

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The obesity epidemic has touched all aspects of obstetric care, including the practice of cesarean delivery. Obesity is an independent risk factor for cesarean delivery, and the increased prevalence of obesity has contributed to the overall rise in primary cesarean delivery seen over the past few decades. Because of the frequent existence of co-morbidities such as hypertension and diabetes, obesity is a plausible contributor to rising maternal mortality. In addition, obese women who undergo both primary and repeat cesarean delivery have a higher chance to develop surgical and post-operative complications, including wound infection and thromboembolic events. Surgical complications increase steadily with increasing maternal weight. In this chapter, we will review the incidence and contributing factors that lead to cesarean delivery in obese patients, peri-operative complications, and strategies to reduce these risks in obese women undergoing cesarean delivery.

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Time From Neuraxial Anesthesia Placement to Delivery is Inversely Proportional to Umbilical Arterial Cord pH at Scheduled Cesarean Delivery

Cited by 6 publications

References 0 publications

Impact of interval between induction of spinal anesthesia to delivery on umbilical arterial cord ph of neonates delivered by elective cesarean section

Impact of interval between induction of spinal anesthesia to delivery on umbilical arterial cord ph of neonates delivered by elective cesarean section

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Obesity: Unique Challenges at the Time of Cesarean Delivery

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