Fetomaternal Outcome in Severe Preeclamptic Women Undergoing Emergency Cesarean Section under Either General Or Spinal Anesthesia

This prospective observational study compared the effects of general and spinal anesthesia in 173 severe preeclamptic women undergoing emergency cesarean section. 146 (84.5%) patients underwent spinal anesthesia (SA) and 27 (15.5%) patients had general anesthesia (GA). Most of the patients were primigravid and nulliparous. Intraoperatively SA group required more intravenous fluid and vasopressor support, while GA group required more preoperative labetalol injection for blood pressure control. Overall 13.3% of patients required critical care, particularly GA group (44.4% versus 7.5%; P < 0.001). Patients receiving GA had a higher mortality (25.9% versus 1.4%; P < 0.001). The length of hospital stay was comparable. Significantly more neonates of patients receiving GA were found to be preterm (77.8% versus 44.5%; P < 0.01) and required advanced resuscitation. GA group also had higher neonatal mortality (29.6% versus 11%; P < 0.05). To conclude, severe preeclamptic mothers receiving general anesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was significantly higher with general anesthesia.

[1]  K. Patil,et al.  Maternal and Perinatal Outcome During Expectant Management of Severe Pre-Eclampsia Between 24 and 34 Weeks of Gestation , 2012, The Journal of Obstetrics and Gynecology of India.

[2]  L. Cronjé,et al.  Observational study of choice of anaesthesia and outcome in patients with severe pre-eclampsia who present for emergency Caesarean section , 2012 .

[3]  W. Marsden.  I and J , 2012 .

[4]  Helen Wilkinson,et al.  Saving Mothers’ Lives. Reviewing maternal deaths to make motherhood safer: 2006–2008 , 2011, BJOG : an international journal of obstetrics and gynaecology.

[5]  K. Osungbade,et al.  Public Health Perspectives of Preeclampsia in Developing Countries: Implication for Health System Strengthening , 2011, Journal of pregnancy.

[6]  M. Paech,et al.  Faculty Opinions recommendation of Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. , 2011 .

[7]  S. Dasgupta,et al.  Comparison of neonatal outcome in women with severe pre-eclampsia undergoing caesarean section under spinal or general anaesthesia. , 2011, Journal of the Indian Medical Association.

[8]  J. Neilson,et al.  Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer: 2006–2008 , 2011, BJOG : an international journal of obstetrics and gynaecology.

[9]  O. Pryds,et al.  Antenatal magnesium sulphate may prevent cerebral palsy in preterm infants—but are we convinced? Evaluation of an apparently conclusive meta‐analysis with trial sequential analysis , 2011, BJOG : an international journal of obstetrics and gynaecology.

[10]  O. Ajuzieogu,et al.  A retrospective study of the outcome of cesarean section for women with severe pre-eclampsia in a third world setting , 2011, Saudi journal of anaesthesia.

[11]  Anshu,et al.  Maternal and Perinatal Outcome in Severe Pre-eclampsia and Eclampsia , 2009 .

[12]  B. Rachet,et al.  Anaesthesia mode for caesarean section and mortality in very preterm infants: an epidemiologic study in the EPIPAGE cohort. , 2009, International journal of obstetric anesthesia.

[13]  O. Okezie,et al.  Anaesthetic management of patients with pre-eclampsia/eclampsia and perinatal outcome , 2009, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[14]  I. Siafaka,et al.  General versus neuraxial anaesthesia for caesarean section: Impact on the duration of hospital stay , 2009, Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology.

[15]  G. Draisci,et al.  Remifentanil for cesarean section under general anesthesia: effects on maternal stress hormone secretion and neonatal well-being: a randomized trial. , 2008, International journal of obstetric anesthesia.

[16]  J. Douglas.  The Use of Neuraxial Anesthesia in Parturients with Thrombocytopenia: What is an Adequate Platelet Count? , 2007 .

[17]  M. Merialdi,et al.  Rates of caesarean section: analysis of global, regional and national estimates. , 2007, Paediatric and perinatal epidemiology.

[18]  D. Chestnut.  Spinal Versus Epidural Anesthesia for Cesarean Delivery in Severe Preeclampsia: A Prospective Randomized, Multicenter StudyVisalyaputra S, Rodanant O, Somboonviboon W, et al (Mahidol Univ, Bangkok, Thailand; Chulalongkom Univ, Bangkok, Thailand; Rajvithi Hosp, Bangkok, Thailand; et al) Anesth Analg , 2006 .

[19]  S. Thienthong,et al.  Spinal versus epidural anesthesia for cesarean delivery in severe preeclampsia: a prospective randomized, multicenter study. , 2006, Anesthesia and analgesia.

[20]  M. Suresh,et al.  Airway problems in pregnancy , 2005, Critical care medicine.

[21]  A. Santos,et al.  Spinal anesthesia for cesarean delivery in severely preeclamptic women: don't throw out the baby with the bathwater! , 2005, Anesthesia and analgesia.

[22]  M. Ahsan-ul-Haq,et al.  ANALYSIS OF OUTCOME OF GENERAL VERSUS SPINAL ANAESTHESIA FOR CAESAREAN DELIVERY IN SEVERE PRE-ECLAMPSIA WITH FOETAL COMPROMISE , 2005 .

[23]  M. Suresh,et al.  Airway problems in pregnancy. , 2004, Critical care clinics.

[24]  J. Moodley,et al.  Epidural compared with general anaesthesia for caesarean delivery in conscious women with eclampsia , 2001, BJOG : an international journal of obstetrics and gynaecology.

[25]  J. Martin,et al.  Cardiopulmonary Morbidity as a Complication of Severe Preeclampsia HELLP Syndrome , 2000, Journal of Perinatology.

[26]  Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. , 2000, American journal of obstetrics and gynecology.

[27]  J. Khoury,et al.  New Ballard Score, expanded to include extremely premature infants. , 1991, The Journal of pediatrics.