Comparison of the effects of general and spinal anesthesia for cesarean delivery on maternal and fetal outcomes: A retrospective analysis of data

Mesure Gul Nihan Ozden, Senem Koruk, Zeynep Collak, Nur Panik, Mesure Gul Nihan Ozden, Senem Koruk, Zeynep Collak, Nur Panik

Abstract

Objective: General or single-shut spinal anesthesia (SA) is applied for cesarean section and both methods of anesthesia have different effects on the mother and newborn. This retrospective study, in which 1-year data were analyzed, was aimed to examine the effects of general or SA on maternal and neonatal outcomes.

Methods: Anesthesia technique, mother's age, gestational age, number of pregnancies, previous cesarean delivery number, maternal complications, and indications for cesarean delivery were analyzed in 883 cesarean deliveries. In addition, weight and Apgar scores of newborn and umbilical cord blood gas values were examined.

Results: Neonatal intensive care need was higher in the general anesthesia (GA) group, Apgar scores were higher in the SA group, but neonatal mortality was similar. The umbilical cord Ph and lactate were lower; PCO2 values were higher in the GA group. Neonatal weight, mother's age, gestational age, and Apgar scores were predictive for neonatal mortality, but anesthesia technique was not.

Conclusion: While umbilical cord blood gas values were less affected and the need for neonatal intensive care was lower with SA, we believe that both anesthesia methods can be used safely for mother and neonatal in cesarean anesthesia considering maternal and neonatal morbidity and mortality.

Keywords: Apgar score; cesarean section; general anesthesia; infant mortality; spinal anesthesia.

Conflict of interest statement

No conflict of interest was declared by the authors.

© Copyright 2023 by Istanbul Provincial Directorate of Health.

References

    1. Saracoglu KT, Derman S, Yakupoğlu S, Demirhan R. General or non-general anesthesia: that is the question. Glob J Anesth. 2019;6:1.
    1. Keleş E, Yazgan H, Gebeşçe A, Pakır E. The type of anesthesia used during cesarean section is related to the transient tachypnea of the newborn. ISRN Pediatr. 2013;2013:264340.
    1. Ngan Kee WD. Confidential enquiries into maternal deaths: 50 years of closing the loop. Br J Anaesth. 2005;94:413–6.
    1. Chen Y, Liu W, Gong X, Cheng Q. Comparison of effects of general anesthesia and combined spinal/epidural anesthesia for cesarean delivery on umbilical cord blood gas values: a double-blind, randomized, controlled study. Med Sci Monit. 2019;25:5272–9.
    1. Laudenbach V, Mercier FJ, Rozé JC, Larroque B, Ancel PY, Kaminski M, et al. Epipage Study Group Anaesthesia mode for caesarean section and mortality in very preterm infants: an epidemiologic study in the EPIPAGE cohort. Int J Obstet Anesth. 2009;18:142–9.
    1. Van de Velde M, Schepers R, Berends N, Vandermeersch E, De Buck F. Ten years of experience with accidental dural puncture and post-dural puncture headache in a tertiary obstetric anaesthesia department. Int J Obstet Anesth. 2008;17:329–35.
    1. Higuchi H, Hirata J, Adachi Y, Kazama T. Influence of lumbosacral cerebrospinal fluid density, velocity, and volume on extent and duration of plain bupivacaine spinal anesthesia. Anesthesiology. 2004;100:106–14.
    1. Bajwa SJ, Bajwa SK, Kaur J, Singh A, Singh A, Parmar SS. Prevention of hypotension and prolongation of postoperative analgesia in emergency cesarean sections: a randomized study with intrathecal clonidine. Int J Crit Illn Inj Sci. 2012;2:63–9.
    1. Shitemaw T, Jemal B, Mamo T, Akalu L. Incidence and associated factors for hypotension after spinal anesthesia during cesarean section at Gandhi Memorial Hospital Addis Ababa, Ethiopia. PLoS One. 2020;15:e0236755.
    1. Farid Z, Mushtaq R, Ashraf S, Zaeem K. Comparative efficacy of crystalloid preloading and co-loading to prevent spinal anesthesia induced hypotension in elective caesarean section. Pak J Med Health Sci. 2016;10:42–5.
    1. Hunie M, Wubishet T, Fenta E, Teshome D, Kibret S, Desse T, et al. The effect of preloading and co-loading in the prevention of hypotension among mothers who underwent cesarean delivery under spinal anesthesia: a prospective cohort study. Sys Rev Pharm. 2022;13:213–8.
    1. Oh AY, Hwang JW, Song IA, Kim MH, Ryu JH, Park HP, et al. Influence of the timing of administration of crystalloid on maternal hypotension during spinal anesthesia for cesarean delivery: preload versus coload. BMC Anesthesiol. 2014;14:36.
    1. Ni HF, Liu HY, Zhang J, Peng K, Ji FH. Crystalloid coload reduced the incidence of hypotension in spinal anesthesia for cesarean delivery, when compared to crystalloid preload: a meta-analysis. Biomed Res Int. 2017;2017:3462529.
    1. Loh SF, Woodworth A, Yeo GS. Umbilical cord blood gas analysis at delivery. Singapore Med J. 1998;39:151–5.
    1. Yamashita A, Irikoma S. Comparison of inflationary non-invasive blood pressure (iNIBP) monitoring technology and conventional deflationary non-invasive blood pressure (dNIBP) measurement in detecting hypotension during cesarean section. JA Clin Rep. 2018;4:5.
    1. Malin GL, Morris RK, Khan KS. Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis. BMJ. 2010;340:c1471.
    1. Ozden Omaygenc D, Dogu T, Omaygenc MO, Ozmen F, Albayrak MD, Babur Guler G, et al. Type of anesthesia affects neonatal wellbeing and frequency of transient tachypnea in elective cesarean sections. J Matern Fetal Neonatal Med. 2015;28:568–72.
    1. Afolabi BB, Lesi FE. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev. 2012;10:CD004350.
    1. Sung TY, Jee YS, You HJ, Cho CK. Comparison of the effect of general and spinal anesthesia for elective cesarean section on maternal and fetal outcomes: a retrospective cohort study. Anesth Pain Med (Seoul) 2021;16:49–55.
    1. Saygı Aİ, Özdamar Ö, Gün İ, Emirkadı H, Müngen E, Akpak YK. Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial. Sao Paulo Med J. 2015;133:227–34.
    1. Sabol BA, Caughey AB. Acidemia in neonates with a 5-minute Apgar score of 7 or greater-What are the outcomes? Am J Obstet Gynecol. 2016;215:486.
    1. Fahey J, King TL. Intrauterine asphyxia: clinical implications for providers of intrapartum care. J Midwifery Womens Health. 2005;50:498–506.
    1. MacLennan A. A template for defining a causal relation between acute intrapartum events and cerebral palsy: international consensus statement. BMJ. 1999;319:1054–9.
    1. Heller G, Schnell RR, Misselwitz B, Schmidt S. Umbilical blood pH, Apgar scores, and early neonatal mortality [Article in German] Z Geburtshilfe Neonatol. 2003;207:84–9.
    1. Goldaber KG, Gilstrap LC, 3rd, Leveno KJ, Dax JS, McIntire DD. Pathologic fetal acidemia. Obstet Gynecol. 1991;78:1103–7.
    1. Ross MG, Gala R. Use of umbilical artery base excess: algorithm for the timing of hypoxic injury. Am J Obstet Gynecol. 2002;187:1–9.
    1. Yousefshahi F, Tanha FD, Kaveh M, Hamidian R, Barkhordari K. The effect of ephedrine on fetal outcome in treatment of maternal hypotension caused by spinal anesthesia during cesarean section. J Fam Reprod Health. 2010;4:149–54.
    1. Kireçci A, Berber H, Bakacak SM, Kalay S. The short-term effect of general and spinal anaesthesia on newborn in elective cesarean deliveries [Article in Turkish] Göztepe Tıp Derg. 2014;29:99–103.
    1. Noboa Salgado M, González Andrade F, Villagómez Aroca DA. Proposal of a new predictive model of mortality in high-risk new-borns and evaluation of its performance. Ecuatorian J Pediatr. 2021;22:1–12.
    1. Ratnasiri AWG, Lakshminrusimha S, Dieckmann RA, Lee HC, Gould JB, Parry SS, et al. Maternal and infant predictors of infant mortality in California, 2007-2015. PLoS One. 2020;15:e0236877.
    1. Shukla VV, Eggleston B, Ambalavanan N, McClure EM, Mwenechanya M, Chomba E, et al. Predictive modeling for perinatal mortality in resource-limited settings. JAMA Netw Open. 2020;3:e2026750.
    1. Mu Y, Li M, Zhu J, Wang Y, Xing A, Liu Z, et al. Apgar score and neonatal mortality in China: an observational study from a national surveillance system. BMC Pregnancy Childbirth. 2021;21:47.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever