Department of Obstetrics and Gynecology, Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, 38 Ramsis Street, Abbasiya, 11591, Cairo, Egypt.
Department of Anesthesia and Intensive Care, Faculty of Medicine, Azhar University, Cairo, Egypt.
BMC Pregnancy Childbirth. 2022 Mar 17;22(1):216. doi: 10.1186/s12884-022-04536-y.
To evaluate the impact of interval between induction of spinal anesthesia to delivery of the fetus by elective cesarean section on umbilical arterial pH and neonatal outcome.
Two hundred and twenty pregnant women who were planned for elective cesarean section at term under spinal anesthesia were recruited. Minimum systolic, diastolic and mean arterial blood pressures (SBP, DBP, MAP) and largest pressure decrease (SBP, DBP, MPA) were also recorded. Induction of spinal anesthesia to delivery interval was measured. Following delivery, umbilical arterial cord analysis for pH and base deficit were done. Apgar scores at 1 min and at 5 min, neonatal intensive care unit (NICU) admission, need for mechanical ventilation and incidence of hypoxemic-ischemic encephalopathy were recorded.
Induction of spinal anesthesia to delivery interval was 25.7 ± 5.6 min. Lowest SBP and MAP reached during cesarean delivery were 88.9 ± 7.3 mmHg and 60.4 ± 5.6 mmHg, respectively. MAP < 65 mmHg was reached in 136 (62%) patients with a decrease of MAP of > 20% in 149 (68%) patients. Duration of the longest hypotension episode was 3.3 ± 2.2 min. All patients required ephedrine administration for hypotensive episodes with an average dosage of 11.4 ± 3.2 mg. Umbilical pH of 7.3 ± 0.1 and base deficit of 8.3 ± 4.4 mmol/l were recorded. Apgar scores at 5 min were 8.5 ± 1.2. Eight (3.6%) neonates were admitted in the NICU. One neonate needed mechanical ventilation. There were no cases of hypoxemic-ischemic encephalopathy. There were inverse correlations between induction of spinal anesthesia to delivery interval, body mass index (BMI) and duration of longest hypotension episode in relation to umbilical pH (r = -0.817, -0.395 and -0.268, respectively). Cut off value for induction of spinal anesthesia to delivery interval greater than 27 min predicted an umbilical pH of < 7.2. Cut off value for the duration of the longest hypotension episode greater than 5 min predicted an umbilical pH of < 7.2. Cut off value for BMI greater than 35 kg/m predicted an umbilical pH of < 7.2.
Prolonged interval between induction of spinal anesthesia to delivery could be associated with neonatal acidosis. This could be aggravated by maternal obesity and prolonged duration of hypotension episodes during cesarean delivery.
评估择期剖宫产孕妇行椎管内麻醉诱导至胎儿娩出的间隔时间对脐动脉 pH 值和新生儿结局的影响。
招募了 220 名在脊髓麻醉下足月择期行剖宫产的孕妇。还记录了最小收缩压、舒张压和平均动脉压（SBP、DBP、MAP）以及最大压力下降（SBP、DBP、MPA）。测量了椎管内麻醉诱导至分娩的间隔时间。分娩后，对脐带进行 pH 值和碱缺失分析。记录 1 分钟和 5 分钟时的 Apgar 评分、新生儿重症监护病房（NICU）入院、需要机械通气和发生低氧缺血性脑病的情况。
椎管内麻醉诱导至分娩的间隔时间为 25.7±5.6 分钟。剖宫产时最低的 SBP 和 MAP 分别为 88.9±7.3mmHg 和 60.4±5.6mmHg。136 名患者（62%）MAP 降至 65mmHg 以下，149 名患者（68%）MAP 下降超过 20%。最长低血压发作持续时间为 3.3±2.2 分钟。所有患者均需使用麻黄碱治疗低血压，平均剂量为 11.4±3.2mg。记录脐动脉 pH 值为 7.3±0.1，碱缺失值为 8.3±4.4mmol/L。5 分钟时 Apgar 评分为 8.5±1.2。8 名（3.6%）新生儿入住 NICU。1 名新生儿需要机械通气。无低氧缺血性脑病病例。
椎管内麻醉诱导至分娩的间隔时间延长与新生儿酸中毒有关。产妇肥胖和剖宫产期间低血压持续时间延长会加重这种情况。
