Associated factors with umbilical arterial pH after cesarean delivery under spinal anesthesia: a retrospective cohort study
Maximum decrease of blood pressure and number of minutes of hypotension were independently associated with umbilical arterial pH. However, the impact of hypotension considering the duration of it on umbilical arterial pH is unknown.
Pregnant women aged ≥ 20 years who delivered a baby at full-term via a cesarean delivery under a single-shot spinal anesthesia between January 2017 and March 2019 were included. The main outcome was to predict umbilical arterial pH, based on the value of the time integral of hypotension. Patient demographics, patient comorbidities, and intraoperative data, including the total dose of ephedrine and phenylephrine by fetal delivery and cumulative duration of maternal hypotension, were evaluated. Maternal hypotension was reflected as a decrease in systolic arterial pressure and mean arterial pressure to < 80% of baseline values. The systolic arterial pressure and mean arterial pressure were independently included in a multiple regression analysis along with all other explanatory factors to predict the umbilical arterial pH.
Of the 416 eligible patients, 381 were enrolled. When including the systolic arterial pressure or mean arterial pressure in the model, emergency cases, the total dose of ephedrine, hypertensive disorders of pregnancy, and systolic arterial pressure or mean arterial pressure values were found to be significant predictive factors of umbilical arterial pH.
Our results suggest that an elevated time integral of maternal hypotension may have a negative impact on umbilical arterial pH. Therefore, to minimize the risk of fetal acidosis, maternal hypotension should be prevented with the consideration of vasopressors selection.
1 A.M. Cyna, M. Andrew, R.S. Emmett, et al. Techniques for preventing hypotension during spinal anaesthesia for caesarean section Cochrane Database Syst Rev., 4 (2006), Article CD002251
2 W.D. Ngan Kee, A. Lee Multivariate analysis of factors associated with umbilical arterial pH and standard base excess after Caesarean section under spinal anaesthesia Anaesthesia., 58 (2003), pp. 125-130
3 B.C. Corke, S. Datta, G.W. Ostheimer, et al. Spinal anaesthesia for Caesarean section. The influence of hypotension on neonatal outcome Anaesthesia., 37 (1982), Article 658e62
4 S. Okudaira, S. Suzuki Influence of spinal hypotension on fetal oxidative status during elective cesarean section in uncomplicated pregnancies Arch Gynecol Obstet., 271 (2005), p. 292e5
5 S.M. Kinsella, B. Carvalho, R.A. Dyer, et al. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia Anaesthesia., 73 (2018), pp. 71-92
6 P.M. Singh, N.P. Singh, M. Reschke, et al. Vasopressor drugs for the prevention and treatment of hypotension during neuraxial anaesthesia for Caesarean delivery: a Bayesian network meta-analysis of fetal and maternal outcomes Br J Anaesth., 124 (2020), pp. e95-e107
7 M. Veeser, T. Hofmann, R. Roth, et al. Vasopressors for the management of hypotension after spinal anesthesia for elective caesarean section. Systematic review and cumulative meta-analysis Acta Anaesthesiol Scand., 56 (2012), pp. 810-816
8 M. Heesen, S. Kölhr, R. Rossaint, et al. Prophylactic phenylephrine for caesarean section under spinal anaesthesia: systematic review and meta-analysis Anaesthesia., 69 (2014), pp. 143-165
9 B.C. Corke, S. Datta, G.W. Ostheimer, et al. Spinal anaesthesia for Caesarean section. The influence of hypotension on neonatal outcome Anaesthesia., 37 (1982), pp. 658-662
10 S. Klöhr, R. Roth, T. Hofmann, et al. Definitions of hypotension after spinal anaesthesia for caesarean section: literature search and application to parturients Acta Anaesthesiol Scand., 54 (2010), pp. 909-921
11 WD Ngan Kee Uteroplacental blood flow DH Chestnut, LS Polleu, LC Tsen, CA Wong (Eds.), Chestnut’s Obstetric Anesthesia: Principles and Practice (6th ed.), Mosby Elsevier, Philadelphia (PA) (2019), pp. 8-55
12 S.M. Burns, C.M. Cowan, R.G. Wilkes Prevention and management of hypotension during spinal anaesthesia for elective Caesarean section: a survey of practice Anaesthesia., 56 (2001), pp. 777-798
13 BH McGhee, EJ Bridges Monitoring arterial blood pressure: what you may not know Crit Care Nurse., 22 (2002), pp. 60-79
14 A. Maayan-Metzger, I. Schushan-Eisen, L. Todris, et al. Maternal hypotension during elective cesarean section and short-term neonatal outcome Am J Obstetrics Gynecol., 202 (2010), pp. e1-5
15 D.R. Bonds, L.O. Crosby, T.G. Cheek, et al. Estimation of human fetal-placental unit metabolic rate by application of the Bohr principle J Dev Physiol., 8 (1986), pp. 49-54
16 WD Ngan Kee, KS Khaw Vasopressors in obstetrics: what should we be using? Curr Opin Anaesthesiol., 19 (2006), pp. 238-243
17 V.G. Henke, B.T. Bateman, L.R. Leffert Focused review: spinal anesthesia in severe preeclampsia Anesth Analg., 117 (2013), pp. 686-693
18 R. Jouppila, A. Hollmén The effect of segmental epidural analgesia on maternal and foetal acid-base balance, lactate, serum potassium and creatine phosphokinase during labour Acta Anaesthesiol Scand., 20 (1976), pp. 259-268
19 E. Ball, J.N. Bulmer, S. Ayis, et al. Late sporadic miscarriage is associated with abnormalities in spiral artery transformation and trophoblast invasion J Pathol., 208 (2006), pp. 535-542
20 P. Kaufmann, S. Black, B. Huppertz Endovascular trophoblast invasion: implications for the pathogenesis of intrauterine growth retardation and preeclampsia Biol Reprod., 69 (2003), pp. 1-7
21 W.D. Ngan Kee, S.W.Y. Lee, F.F. Ng, et al. Randomized double-blinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anesthesia for cesarean delivery Anesthesiolog., 122 (2015), pp. 736-745