Affiliations: [a] WakeMed Physician Practices, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Raleigh, NC, USA
| [b] Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| [c] Department of Maternal and Child Health, Gillings School of Global Public Health, Chapel Hill, NC, USA
| [d] Department of Biostatistics, Gillings School of Public Health, University of North Carolina at Chapel Hill, NC, USA
| [e] Department of Anesthesiology; University of North Carolina School of Medicine, Chapel Hill, NC, USA
Correspondence:
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Address for correspondence: Robert Strauss, 3010 Old Clinic Building, CB# 7516. UNC School of Medicine; Chapel Hill, NC 27599, USA. Tel.: +1 919 966 1601; Fax: +1 919 966 6377; E-mail: [email protected].
Abstract: OBJECTIVE:Both preeclampsia and neuraxial anesthesia can alter placental perfusion, potentially affecting the neonatal status. The objective of our study is to quantify the association between type of neuraxial anesthetic and short-term neonatal morbidity among preeclamptic patients undergoing cesarean delivery. METHODS:We performed a secondary analysis of a prospective observational cohort study. Women with singleton gestations and a diagnosis of preeclampsia who underwent cesarean delivery with neuraxial anesthesia were included in the analysis. Short-term neonatal morbidities, defined as neonatal intensive care unit (NICU) admission, arterial cord gas pH ≤7.2 and 5-minute Apgar <7, were compared based on type of neuraxial anesthetic. RESULTS:A total of 4100 patients were included in the analysis, 1696 (41.4%) received spinal anesthesia 1848 (45.1%) received epidural anesthesia and 556 (13.5%) received a combined spinal-epidural (CSE). Antepartum and intrapartum characteristics significantly differed between the groups (p≤0.02). After adjusted analysis, spinal anesthesia was associated with reduced odds of NICU admission, compared with epidural or CSE (OR; 95% CI: 0.79; 0.63–0.98, 0.71; 0.53–0.94, respectively). Spinal anesthesia was also associated with lower odds of a 5-minute Apgar <7 compared with epidural anesthesia (OR 0.59; 95% CI; 0.43–0.83). We found no association between type of anesthesia and arterial cord pH ≤7.2. In stratiifed analysis by gestational age, no association between the type of neuraxial anesthesia and neonatal outcomes was noted among term infants, but associations persisted in preterm infants. CONCLUSIONS:Among women with preeclampsia undergoing cesarean delivery, spinal anesthesia may be associated with reduced short-term neonatal morbidity in preterm infants, compared with epidural or CSE.
