EFFECT OF MATERNAL ANAESTHESIA ON NEONATAL OUTCOMES: A PROSPECTIVE COHORT STUDY IN A TERTIARY CARE INSTITUTE OF HALDIA, WEST BENGAL
Main Article Content
Keywords
Spinal anaesthesia, Neonatal outcome, Cesarean section, NICU admission, APGAR score etc.
Abstract
Background: Spinal anaesthesia is the preferred technique for cesarean section due to its rapid onset and maternal safety profile. However, maternal hypotension following spinal anaesthesia may adversely affect neonatal outcomes. This study aimed to evaluate the impact of maternal hypotension on various neonatal parameters.
Methods: A prospective cohort study was conducted at ICARE Institute of Medical Sciences and Research & Dr. B. C. Roy Hospital, Haldia, West Bengal from May 2023 to May 2024. A total of 220 term parturients undergoing cesarean section under spinal anaesthesia were enrolled. Maternal hypotension was defined as systolic blood pressure <100 mmHg or a fall of ≥20% from baseline. Neonatal outcomes including APGAR scores, need for resuscitation, NICU admission and duration, birth weight, cord blood pH, respiratory distress and neonatal jaundice were compared between mothers with and without hypotension. Data were analyzed using SPSS version 25.0.
Results: Out of 220 patients, 84 (38.2%) experienced maternal hypotension. The mean APGAR score at 1 minute was significantly lower in the hypotension group (6.9 ± 1.4 vs 7.6 ± 0.9; p=0.01). NICU admission was more frequent among neonates of hypotensive mothers (16.7% vs 3.7%; p=0.002), with a higher rate of prolonged NICU stay >3 days (p=0.012). Neonatal resuscitation (13.1% vs 4.4%; p=0.03), respiratory distress (15.5% vs 5.1%; p=0.01), and acidosis (cord pH <7.2; 17.9% vs 7.4%; p=0.02) were also significantly associated with maternal hypotension. No significant difference was observed in the incidence of neonatal jaundice requiring phototherapy.
Conclusion: Maternal hypotension following spinal anaesthesia is significantly associated with adverse neonatal outcomes, including low APGAR scores, need for resuscitation, respiratory distress, and prolonged NICU stay. Vigilant intraoperative monitoring and timely management of hypotension are essential to ensure optimal neonatal outcomes in cesarean deliveries under spinal anaesthesia.
References
2. Afolabi BB, Lesi FE. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev. 2012;(10):CD006912.
3. Ng K, Parsons J, Cyna AM, Middleton P. Spinal versus epidural anaesthesia for caesarean section. Anaesthesia. 2004;59(12):1114–20.
4. Kinsella SM, Carvalho B, Dyer RA, et al. International consensus on obstetric anesthesia. Anaesthesia. 2018;73(1):71–92.
5. Hood DD, Dewan DM. Anesthetic and obstetric outcome in elective cesarean section patients: A comparison of general and regional anesthesia. Anesthesiology. 1993;79(3):470–6.
6. Reynolds F. Bupivacaine for spinal anaesthesia in obstetrics. Br J Anaesth. 2011;107(1):72–8.
7. Dyer RA, Reed AR, James MF. Obstetric spinal hypotension and neonatal outcome. Curr Opin Anaesthesiol. 2012;25(3):300–5.
8. Ngan Kee WD. Prevention of maternal hypotension after regional anesthesia. Anaesthesia. 2010;65 Suppl 1:28–34.
9. Morgan PJ, Halpern SH, Tarshis J. The effect of maternal hypotension on fetal heart rate and neonatal outcomes. Anesth Analg. 2001;93(6):1570–4.
10. Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score. Obstet Gynecol. 2001;98(4):695–9.
11. Habib AS. Spinal anesthesia for cesarean delivery: advantages and limitations. Anesth Analg. 2012;114(1):70–8.
12. Sharma SK, Philip J, Whitten CW, Padakandla UB, Landers DF. Impact of hypotension on neonatal outcomes. Anesthesiology. 1997;87(3):529–35.
13. Klöhr S, Roth R, Hofmann T, Rossaint R, Heesen M. Definitions of hypotension after spinal anaesthesia for caesarean section: Literature search and application to parturients. Acta Anaesthesiol Scand. 2010;54(8):909–21.
14. Klohr S, et al. Is a drop in maternal blood pressure dangerous for the baby? Anaesthesia. 2011;66(2):138–43.
15. Dyer RA, Butwick AJ, Carvalho B. Maintaining maternal blood pressure during spinal anaesthesia for caesarean delivery: What is the optimal goal? Br J Anaesth. 2015;115(4):505–8.
16. Klumpner TT, Pagel PS, Warltier DC. Spinal anaesthesia-induced maternal hypotension and neonatal outcomes. J Clin Anesth. 2013;25(3):190–5.
17. Dyer RA, Rout CC, Rocke DA. A comparison of phenylephrine and ephedrine in the maintenance of arterial pressure during spinal anaesthesia for caesarean section. Anesth Analg. 2004;98(3):815–21.
18. Ngan Kee WD, Khaw KS. Vasopressors in obstetrics: What should we be using? Curr Opin Anaesthesiol. 2006;19(3):238–43.
19. Cohen SE, Yentis SM, Gatt SP, et al. Neonatal respiratory outcomes following spinal anaesthesia for cesarean section. Anaesth Intensive Care. 1997;25(3):297–301.
20. Maisels MJ, Watchko JF, Bhutani VK, et al. Bilirubin and neurotoxicity in the preterm infant. Clin Perinatol. 2016;43(2):263–81.
21. Mercier FJ, Augè M, Hoffmann C, Fischer C. Maternal hypotension during spinal anesthesia for cesarean delivery. Minerva Anestesiol. 2013;79(1):62–73.
22. Langesaeter E, Dyer RA. Maternal hypotension and fetal heart rate changes associated with spinal anesthesia for cesarean section. Curr Opin Anaesthesiol. 2011;24(3):286–91.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Diptanu Bhaumik
Assistant Professor, Department of Anaesthesiology, ICARE Institute of Medical Sciences and Research & Dr B C Roy Hospital, Haldia, West Bengal, Pincode 721645
Dr Koushik Baran Roy
Post Graduate Resident, Department of Anaesthesiology, ICARE Institute of Medical Sciences and Research & Dr B C Roy Hospital
Dr Deepak Chandra
Associate Professor, Department of Anaesthesiology ICARE, Institute of Medical Sciences and Research & Dr B C Roy Hospital
Dr Arup Dasgupta
Professor and HOD, Department of Anaesthesiology ICARE, Institute of Medical Sciences and Research & Dr B C Roy Hospital