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Retrospective assessment of the effect of anesthetic type for cesarean delivery on neonatal acid-base status
Abstract Number: S 33
Abstract Type: Original Research
While the benefits of spinal anesthesia (SA) for cesarean delivery (CD) are well documented for the mother, its impact on neonatal outcomes is less clear. A previous meta-analysis reported that cord pH was significantly lower with SA compared to general (GA) or epidural (EP) anesthesia.1 Ephedrine, which is associated with lower cord pH compared to phenylephrine, was however used to treat hypotension in the majority of included studies. As such, the aim of this study was to re-evaluate the effects of anesthesic technique for CD on cord pH now that phenylephrine has replaced ephedrine in our practice.
We searched our databases to identify patients who underwent CD and had cord blood gases available. We collected information about type of anesthesia, indication for CD, umbilical artery pH, gestational age, birth weight, maternal comorbidities, pregnancy complications, fetal issues (anomalies, non-reassuring fetal heart tones (NRFHT), growth restriction), and perioperative factors (phenylephrine use, skin incision to delivery time, uterine incision to delivery time). We decided a priori to test separately cases where CD was performed emergently for fetal or maternal indications (NRFHT, abruption, suspected uterine rupture, severe pre-eclampsia and cord prolapse) and those with no such indications. Preoperative characteristics and comorbidities were tested for association with cord blood pH; characteristics with an association of p <0.10 were included in a multivariable model, and non-significant terms were removed one at a time until only those simultaneously significant at p<0.05 remained. The effect of type of anesthesia was then tested in models with this set of covariables.
A total of 1119 cases were included in the analysis [659 with emergent indication (233 EP, 135 GA, 291 SA) and 460 with no emergent indication (100 EP, 47 GA, 313 SA). In cases without an emergent indication, anesthesia type was not a significant predictor of arterial cord pH, whereas maternal weight, presence of fetal anomalies and receipt of phenylephrine were significant predictors of low arterial cord pH. With emergent CD, anesthesia type, abruption, NRFHT, PPROM, maternal BMI, and diabetes were significant predictors of lower arterial cord pH. Specifically, the mean±SD cord pH was significantly lower with GA (7.16±0.16) compared to SA (7.23±0.11, P<0.0001) or EP (7.23±0.11, P<0.0001), with no significant differences between SA and EP.
Arterial cord pH was significantly lower with GA compared with SA and EP for emergent CD, but there was no difference between the anesthesia types for non-emergent cases. The lower pH with GA in emergent cases might reflect a selection bias. In contract to previous data,1 SA was not associated with lower cord pH compared to other anesthesia types. This might be due to the use of phenylephrine as a vasopressor in our practice.
1) Anaesthesia 2005;60:636-653.