Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, the Department of Obstetrics and Gynecology, NYC Health and Hospitals/Elmhurst, Elmhurst, the Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, and the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
Obstet Gynecol. 2022 Dec 1;140(6):950-957. doi: 10.1097/AOG.0000000000004968. Epub 2022 Nov 2.
To evaluate whether patients with obesity who undergo scheduled cesarean delivery under neuraxial anesthesia are at increased risk for umbilical artery pH less than 7.1 and base deficit 12 mmol or greater.
We conducted a multicenter, retrospective cohort study of individuals who delivered a term, singleton, nonanomalous neonate at one of four academic medical centers in New York City from 2013 to 2019 by scheduled cesarean under neuraxial anesthesia for whom fetal cord blood gas results were available. The primary study outcome was rate of fetal acidosis , defined as umbilical artery pH less than 7.1. This was compared between patients with obesity (body mass index [BMI] 30 or higher) and those without obesity (BMI lower than 30). Base deficit 12 mmol or greater and a composite of fetal acidosis and base deficit 12 mmol or greater were also compared. Secondary outcomes included neonatal intensive care unit admission rate, 5-minute Apgar score less than 7, and neonatal morbidity. Associations between maternal BMI and study outcomes were assessed using multivariable logistic or linear regression and adjusted for age, race and ethnicity, insurance type, cesarean delivery order number, and neuraxial anesthesia type.
Of the 6,264 individuals who met inclusion criteria during the study interval, 3,098 had obesity and 3,166 did not. The overall rate of umbilical artery cord pH less than 7.1 was 2.5%, and the overall rate of umbilical artery base deficit 12 mmol or greater was 1.5%. Patients with obesity were more likely to have umbilical artery cord pH less than 7.1 (adjusted odds ratio [aOR] 2.7, 95% CI 1.8-4.2) and umbilical artery base deficit 12 mmol or greater (aOR 3.2, 95% CI 1.9-5.3). This association was not significantly attenuated after additional adjustments for potential mediators, including maternal medical comorbidities. We found no differences in secondary outcomes between groups.
Maternal obesity is associated with increased odds of arterial pH less than 7.1 and base deficit 12 mmol or greater at the time of scheduled cesarean delivery under neuraxial anesthesia.
评估在椎管内麻醉下行择期剖宫产的肥胖患者脐带血 pH 值<7.1 和碱剩余 12mmol 或更大的发生率是否增加。
我们进行了一项多中心、回顾性队列研究，纳入了 2013 年至 2019 年期间在纽约市的四家学术医疗中心行择期椎管内麻醉下剖宫产分娩、单胎、非畸形新生儿的个体，且这些患者的胎儿脐带血气结果可用。主要研究结局是胎儿酸中毒的发生率，定义为脐带血 pH 值<7.1。将肥胖患者（体重指数[BMI]≥30）与非肥胖患者（BMI<30）进行比较。还比较了碱剩余 12mmol 或更大和酸中毒与碱剩余 12mmol 或更大的复合结局。次要结局包括新生儿重症监护病房（NICU）入住率、5 分钟 Apgar 评分<7 分和新生儿发病率。使用多变量逻辑或线性回归评估 BMI 与研究结局之间的相关性，并根据年龄、种族和民族、保险类型、剖宫产手术顺序和椎管内麻醉类型进行调整。
在研究期间符合纳入标准的 6264 名个体中，3098 名患者肥胖，3166 名患者非肥胖。总的脐带血 pH 值<7.1 的发生率为 2.5%，总的脐带血碱剩余 12mmol 或更大的发生率为 1.5%。肥胖患者的脐带血 pH 值<7.1（校正优势比[aOR]2.7，95%CI 1.8-4.2）和脐带血碱剩余 12mmol 或更大（aOR 3.2，95%CI 1.9-5.3）的发生率更高。在对潜在中介因素（包括产妇合并症）进行额外调整后，这种关联并未显著减弱。两组间次要结局无差异。
在椎管内麻醉下行择期剖宫产时，肥胖与脐带血 pH 值<7.1 和碱剩余 12mmol 或更大的发生风险增加相关。
