Outcomes associated with anaesthetic techniques for caesarean section in low- and middle-income countries: a secondary analysis of WHO surveys

Pisake Lumbiganon, Hla Moe, Siriporn Kamsa-Ard, Siwanon Rattanakanokchai, Malinee Laopaiboon, Chumnan Kietpeerakool, Nampet Jampathong, Monsicha Somjit, José Guilherme Cecatti, Joshua P Vogel, Ana Pilar Betran, Suneeta Mittal, Maria Regina Torloni, Pisake Lumbiganon, Hla Moe, Siriporn Kamsa-Ard, Siwanon Rattanakanokchai, Malinee Laopaiboon, Chumnan Kietpeerakool, Nampet Jampathong, Monsicha Somjit, José Guilherme Cecatti, Joshua P Vogel, Ana Pilar Betran, Suneeta Mittal, Maria Regina Torloni

Abstract

Associations between anaesthetic techniques and pregnancy outcomes were assessed among 129,742 pregnancies delivered by caesarean section (CS) in low- and middle-income countries (LMICs) using two WHO databases. Anaesthesia was categorized as general anaesthesia (GA) and neuraxial anaesthesia (NA). Outcomes included maternal death (MD), maternal near miss (MNM), severe maternal outcome (SMO), intensive care unit (ICU) admission, early neonatal death (END), neonatal near miss (NNM), severe neonatal outcome (SNO), Apgar score <7 at 5 minutes, and neonatal ICU (NICU) admission. A two-stage approach of individual participant data meta-analysis was used to combine the results. Adjusted odds ratio (OR) with 95% confidence intervals (CIs) were presented. Compared to GA, NA were associated with decreased odds of MD (pooled OR 0.28; 95% CI 0.10, 0.78), MNM (pooled OR 0.25; 95% CI 0.21, 0.31), SMO (pooled OR 0.24; 95% CI 0.20,0.28), ICU admission (pooled OR 0.17; 95% CI 0.13, 0.22), NNM (pooled OR 0.63; 95% CI 0.55, 0.73), SNO (pooled OR 0.55; 95% CI 0.48, 0.63), Apgar score <7 at 5 minutes (pooled OR 0.35; 95% CI 0.29, 0.43), and NICU admission (pooled OR 0.53; 95% CI 0.45, 0.62). NA therefore was associated with decreased odds of adverse pregnancy outcomes in LMICs.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Forest plot of the pooled estimates of maternal outcomes from WHOGS and WHOMCS datasets. Note: GA = general anaesthesia, SA = spinal anaesthesia, EA = epidural anaesthesia, NA = neuraxial anaesthesia, NICU = neonatal intensive care unit. Intended NA included data of women undergoing SA and EA and those who received >1 type of anaesthesia Intended NA included data of women undergoing SA and EA and those who received >1 type of anaesthesia.
Figure 3
Figure 3
Forest plot of the pooled estimates of neonatal outcomes from WHOGS and WHOMCS datasets. Note: GA = general anaesthesia, SA = spinal anaesthesia, EA = epidural anaesthesia, NA = neuraxial anaesthesia, NICU = neonatal intensive care unit. Intended NA included data of women undergoing SA and EA and those who received >1 type of anaesthesia. Intended NA included data of women undergoing SA and EA and those who received >1 type of anaesthesia.

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