///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

Transient Maternal Hypotension: Risk Factor for NICU Admission after C-section?

Abstract Number: T2B-279
Abstract Type: Original Research

Alejandra Valladolid MD, FAAP 1 ; Catherine Proctor MS2; Stephanie Vickrey RT3; Amy Spots MBA, BSN, RN, NE-BC4; Lori Yates Hodges RN, MSN5; Paul Winchester MD6

Background: Higher incidence of respiratory distress/NICU admission has been reported in infants delivered by elective repeat c-section versus VBAC[1]. Maternal hypotension during c-section as a potential contributor to the increased risk for NICU admission has not been investigated. Many factors affect uterine perfusion in the operating room including maternal supine positioning and regional anesthesia. Severity of maternal hypotension and preventive strategies by anesthesiologists are variable we sought to investigate these in elective c-sections at term and its association with risk of NICU admission.

Methods: Retrospective mother/baby chart review of elective c-sections at term gestational age over 12 months. Maternal risk factors were characterized. Percent declines in predelivery maternal blood pressure were calculated for each case. The blood pressure declines were compared to adverse neonatal outcomes: (APGARS, need for resuscitation, need for respiratory support and need for NICU admission).

Results: A total of 214 charts were reviewed (2016-2017). Mean gestation at delivery was 38 weeks. All deliveries were performed with regional anesthesia (spinal). NICU admission rate (NAR) was 8.4% overall and significantly associated with: maternal diabetes, current tobacco use, fetal growth abnormalities and ASA score. But not significantly associated with maternal age, race/ethnicity, and fetal heart rate categories. Average maternal blood pressure declines were: 38 torr (26%) systolic, 27 torr (33%) diastolic and 30 torr (29%) mean. Systolic maternal blood pressure decline (sMBPD ≥30% occurred in 79/214 (37%) cases. sMBPD ≥30% was associated with significantly lower APGAR1 (7.86 vs 8.22) p=.007 and lower APGAR 5 (8.69 vs 8.93) p=0.01. Neonatal resuscitative interventions were more likely if sMBPD ≥30% vs <30% (34% vs 14%) p=.0005. NAR was 4.4% in sMBPD<30% vs 15.1% for ≧ 30%(p=.006). sMBPD varied significantly by providers including the use of prophylactic vasoconstrictor administration suggesting an important difference among providers.

Conclusion(s): NAR after elective c-section at term is > 3 times higher when sMBPD is >30% prior to delivery and predicted by prenatal factors. Modifications in anesthesia practice may reduce NICU admission risk in term planned c-sections.

1. Kamath, B.D., et al., Neonatal outcomes after elective cesarean delivery. Obstet Gynecol, 2009. 113(6): p. 1231-8.

SOAP 2019