DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20192116

Prospective, non-randomized, parallel group, comparative observational study to compare maternal and neonatal outcome after regional and general anesthesia for Lower Segment Caesarean Section

Pundarikaksha H. P., Tushar J. Tamboli, Narendra Babu M. C., Shruthi R., Akshatha S.

Abstract


Background: LSCS is a routine obstetric procedure performed under general anesthesia (GA) or regional anesthesia (RA). Choice of anesthesia depends on factors like gestational age, parity, co-morbidities, urgency of situation, etc. Both GA and RA involve the use of various medications which may influence maternal and neonatal outcome. As there are few studies comparing maternal and fetal outcome in RA and GA for LSCS in Indian population, the present study was taken up. Objectives of the study was to compare the maternal and neonatal outcome after RA and GA for LSCS.

Methods: 60 subjects with indications for LSCS were assigned non-randomly into two groups, 30 for GA and 30 for RA, at the discretion of anesthesiologist. The demographic, anthropometric and clinical data was recorded for all subjects. The maternal outcome after RA and GA for LSCS was assessed by parameters like maternal blood loss, postoperative pain, postoperative nausea and vomiting, maternal satisfaction and neonatal outcome by parameters like birth weight, APGAR scores and NICU admissions. The maternal and neonatal outcome between the two groups was compared.

Results: All subjects had clear indications for CS. In most of the subjects it was undertaken as an emergency procedure. GA was preferred in high risk subjects. Maternal blood loss, postoperative pain, NICU admissions, need for resuscitation was less under RA compared to GA. There was no difference in PONV, maternal satisfaction, birth weight and need for intubation.

Conclusions: LSCS under RA showed a more favourable maternal and neonatal outcome.


Keywords


GA, LSCS, Maternal and Neonatal outcome, RA

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References


Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY, editors. Williams Obstetrics. 23rd Ed. New York: The McGraw Hill companie. 2010;544-564.

Dutta DC, Konar H, editors. Textbook of Obstetrics. 7th ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2011:563-598.

Low J. Caesarean section-past and present. J Obstet Gynaecol Can. 2009 Dec 1;31(12):1131-36.

Van Dongen PWJ. Caesarean section- etymology and early history. South Afr J Obstet Gynaecol. 2009;15(2):62-6.

Rollins M, Lucero J. Overview of anesthetic considerations for caesarean delivery. British Medical Bulletin. 2012;101:105-25.

Afolabi BB, Lesi AFE, Merah NA. Regional versus general anaesthesia for caesarean section. Cochrane Database of Systematic Reviews. 2006;(4):CD004350.

Hughes SC, Levinson G, Rosen MA, editors. Shnider and Levenson’s anesthesia for obstetrics. 4th ed. Philadelphia: Lippincott William’s and Wilkins; 2002:201-236.

Aly A, Ramadani HM. Assessment of blood loss during cesarean section under general anesthesia and epidural analgesia using different methods. AJAIC. 2006;9(1):25-34.

Ismail S, Shahzad K, Shafiq F. Observational study to assess the effectiveness of postoperative pain management of patients undergoing elective cesarean section. J Anaesthesiol Clin Pharmacol. 2012;28(1):36-40.

Jabalameli M, Honarmand A, Safavi M, Chitsaz M. Treatment of postoperative nausea and vomiting after spinal anesthesia for cesarean delivery: A randomized, double-blinded comparison of midazolam, ondansetron, and a combination. Adv Biomed Res. 2012;1(1):1-7.

Zahir J, Syed S, Jabeen N, Anjum Q, Rehman SU. Maternal and neonatal outcome after spinal versus general anesthesia for caesarean delivery. Ann Pak Inst Med Sci. 2011;7(3):115-18.

Mekonen S, Eshete A, Desta K, Molla Y. Maternal and neonatal outcomes in mothers who undergo caesarean section under general and spinal anesthesia in Gandhi Memorial hospital, Addis Ababa. Adv Tech Biol Med. 2015;3:119.

Saracoglu KT, Saracoglu A, Umuroglu T, Eti Z. Neuraxial block versus general anesthesia for caesarean section: post-operative pain scores and analgesic requirements. J Pak Med Assoc. 2012;62(5):441-4.

Abdissa Z, Awoke T, Belayneh T, Tefera Y. Birth outcome after caesarean section among mothers who delivered by caesarean section under general and spinal anesthesia at Gondar university teaching hospital north-west ethiopia. J Anesth Clin Res. 2013;4:335.

Martin TC, Bell P, Ogunbiyi O. Comparison of general anaesthesia and spinal anaesthesia for caesarean section in Antigua and Barbuda. West Indian Med J. 2007;56(4):330-3.

Solangi SA, Siddiqui SM, Khaskheli MS, Siddiqui MA. Comparison of the effects of general vs spinal anesthesia on neonatal outcome. Anaesth, Pain &Intensive Care. 2012;16(1):18-23.

Aiman J, Mahmood KT, Hussain R, Naeem R. Comparison of spinal/epidural and general anaesthesia in elective c-section patient’s vs doctor’s choice. International Journal of Pharmaceutical Sciences. 2010;2(2):98-106.

Fischer SP, Bader AM, Sweitzer BJ. Preoperative evaluation. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, editors. Miller’s Anesthesia. 7th ed. Philadelphia: Churchill Livingstone Elsevier publisher; 2010:1001-1067.

Bloom SL, Spong CY, Weiner SJ, Landon M B, Rouse D J, Varner MW, et al. Complications of anesthesia for cesarean delivery. The American College of Obstetricians and Gynecologists. 2005;106(2):281-7.

Fabris LK, Maretic A. Effects of general anaesthesia versus spinal anaesthesia for caesarean section on postoperative analgesic consumption and postoperative pain. Periodicum Biologorum. 2009;111(2):251-5.

Busaidi IA, Al-Farsi Y, Ganguly S, Gowri V. Obstetric and non-obstetric risk factors for cesarean section in Oman. Oman Med J. 2012;27(6):478-81.

Al-Mulhim A, Abu-Heija AT, Ali AHM, Bahnasy A. Factors affecting the rate and the indications of primary caesarean section. Bahrain Med Bull. 2001;23(4):160-62.

Oliver-Williams C, Fleming M, Monteath K, Wood AM, Smith GCS. Changes in association between previous therapeutic abortion and preterm birth in scotland, 1980 to 2008: A Historical Cohort Study. PLOS Med. 2013;10(7):1-11.

Ojha N. Obstetric factors and pregnancy outcome in placenta previa. J Ins Med. 2012;34(2):38-41.

Patel RR, Peters TJ, Murphy DJ. Prenatal risk factors for caesarean section. Analysis of ALSPAC cohort of 12944 women in England. International Journal of Epidemiology. 2005;34:353-67.

Timofeev J, Reddy UM, Huang CC, Driggers RW, Landy HJ, Laughon SK. Obstetric complications, neonatal morbidity and indications for cesarean delivery by maternal age. Obstet Gynecol. 2013;122(6):1184-95.

Rowaily MAA, Alsalem FA, Abolfotouh MA. Cesarean section in a high-parity community in Saudi Arabia: clinical indications and obstetric outcomes. BMC Pregnancy and Child birth. 2014;14:92.

Paez LJJ, Navarro JR. Regional versus general anesthesia for cesarean section delivery. Rev Colomb Anestesiol. 2012; 40(3):203-6.

Chattopadhyay S, Das A, Pahari S. Fetomaternal outcome in severe preeclamptic women undergoing emergency cesarean section under either general or spinal anesthesia. Journal of Pregnancy. 2014:1-10.

Sheela SR, Aparna P. A study of maternal and fetal outcome in multifetal gestation at a rural based teaching hospital- A retrospective analysis. Int J Biol Med Res. 2014;5(2):3994-7.