Department of Gynecology and Urogynecology, Andrzej Frycz Modrzewski Krakow University, Cracow, Poland.
Department of Gynecology and Obstetrics, Uniwersytet Warminsko-Mazurski Wydzial Nauk Medycznych, Olsztyn, Poland.
J Matern Fetal Neonatal Med. 2020 Oct;33(20):3445-3452. doi: 10.1080/14767058.2019.1574740. Epub 2019 Feb 10.
There is a great number of studies dealing with the impact of birth anesthesia on the course of labor and condition of the newborn. The aim of this study was to investigate the impact of birth anesthesia on the parameters of oxygenation and acid-base balance in umbilical cord blood. Subjects were divided into four groups: vaginal delivery without anesthesia, vaginal delivery with epidural anesthesia, delivery by cesarean section under a subarachnoid block, and delivery by cesarean section under general anesthesia. The study included mothers aged 18-45 and their newborns born from a singleton normal pregnancy lasting 37-42 weeks, calculating the date of birth according to Naegele's Rule, which was confirmed by ultrasound assessment. The inclusion criteria were a birth weight between 2800 and 4100 g Hematocrit, total hemoglobin, blood oxygen capacity and carboxyhemoglobin content (umbilical artery and vein mean values respectively in all study groups: 41.9 and 42.6%, 14.3 and 14.5 g/dl, 19.3 and 19.6 ml/dl) were similar in all groups and did not correlate with pH in either group. The mean pH value of umbilical cord arterial blood in the "vaginal delivery with epidural anesthesia" group was 7.27 and was significantly the lowest ( < .05) of all the examined groups, in the remaining groups, the mean values ranged between 7.29 and 7.30. Hemoglobin oxygen saturation, oxygenated hemoglobin content, and total oxygen content in umbilical cord blood were statistically significant ( < .001), almost twice as high in cesarean sections under general anesthesia than in cases of regional anesthesia regardless of the method of delivery. Vaginal deliveries had intermediate values of oxygenation parameters. Blood oxygenation of the fetus is a very good parameter to evaluate the clinical state of the baby. Due to most common hypotension of the mother by the regional anesthesia (subarachnoid or epidural), which is compensated by the application of the vasoconstrictors or only by the fluids, it comes to decrease in the oxygen supply of the fetus. We consider in this study that the general anesthesia can be, in some cases, more indicated than the regional anesthesia. The decision of which kind of anesthesia should be used needs to be made by the anesthetists and also by the obstetrician because it can affect the neonatal state after the delivery. It also needs to be mentioned that the time between the start of the anesthesia and the extraction of the fetus by the cesarean section should be as short as possible.
有大量研究探讨了分娩麻醉对分娩过程和新生儿状况的影响。本研究旨在探讨分娩麻醉对脐血氧合和酸碱平衡参数的影响。研究对象分为四组：无麻醉的阴道分娩、硬膜外麻醉的阴道分娩、蛛网膜下腔阻滞下的剖宫产和全身麻醉下的剖宫产。研究纳入年龄在 18-45 岁之间的母亲及其在 37-42 周正常单胎妊娠期间分娩的新生儿，根据 Naegele 规则计算预产期，通过超声评估确认。纳入标准为出生体重在 2800-4100g 之间。研究各组的红细胞压积、总血红蛋白、血氧容量和碳氧血红蛋白含量（脐动脉和脐静脉的平均值分别为 41.9%和 42.6%、14.3g/dl 和 14.5g/dl、19.3ml/dl 和 19.6ml/dl）在各组之间相似，与两组的 pH 值均无相关性。硬膜外麻醉下阴道分娩组的脐动脉血平均 pH 值为 7.27，明显低于其他检查组（ < .05），在其余组中，平均值在 7.29-7.30 之间。脐血血红蛋白氧饱和度、氧合血红蛋白含量和总氧量均有统计学意义（ < .001），全身麻醉下的剖宫产几乎是区域麻醉（无论分娩方式如何）的两倍。阴道分娩的氧合参数值处于中间水平。胎儿血氧是评估婴儿临床状态的一个非常好的参数。由于母亲的局部麻醉（蛛网膜下腔或硬膜外麻醉）最常见的低血压，通过应用血管收缩剂或仅通过液体来代偿，这会导致胎儿的氧供应减少。在本研究中，我们认为全身麻醉在某些情况下比区域麻醉更合适。应该由麻醉师和产科医生来决定使用哪种麻醉，因为这会影响分娩后的新生儿状态。还需要提到的是，从开始麻醉到剖宫产取出胎儿的时间应尽可能短。
