Time from neuraxial anesthesia placement to delivery is inversely proportional to umbilical arterial cord pH at scheduled cesarean delivery

Rimsza, Rebecca R.; Perez, William M.; Babbar, Shilpa; O’Brien, Megan; Vricella, Laura K.

doi:10.1016/j.ajog.2019.01.006

Cited by 24 publications

(37 citation statements)

References 21 publications

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“…In our cohort, obesity was associated with a longer interval from neuraxial anesthesia placement to delivery and from skin incision to delivery and lower intraoperative diastolic blood pressure, which may partially explain our findings, because these variables are on the causal pathway from obesity to fetal acidosis. 19,20 Further, underlying medical conditions, such as hypertension and diabetes mellitus, were increased in the cohort with obesity and may mediate our observed association. However, our effect estimates were not markedly attenuated after adjusting for time from skin incision to delivery, blood pressure nadir, and maternal comorbidities, suggesting the role of other unmeasured consequences of obesity in precipitating fetal acidosis.…”

Section: Discussionmentioning

confidence: 75%

Association Between Obesity and Fetal Acidosis at Scheduled Cesarean Delivery

DeBolt

Sarker

Trejo

et al. 2022

Obstetrics &Amp; Gynecology

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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. METHODS: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. RESULTS: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.CONCLUSION: 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.

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Section: Discussionmentioning

confidence: 75%

Association Between Obesity and Fetal Acidosis at Scheduled Cesarean Delivery

DeBolt

Sarker

Trejo

et al. 2022

Obstetrics &Amp; Gynecology

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“…Although longer spinal-to-incision times are not regarded as harmful to the parturient, some data indicate that it may pose a threat to neonatal wellbeing [21]. In urgent cases the time constraint may become one of the most important factors.…”

Section: Discussionmentioning

confidence: 99%

Fixed Dose versus Height-Adjusted Conventional Dose of Intrathecal Hyperbaric Bupivacaine for Caesarean Delivery: A Prospective, Double-Blinded Randomised Trial

Białowolska¹,

Horosz²,

Sękowska³

et al. 2020

JCM

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The optimal intrathecal dose of local anaesthetic for caesarean section (CS) anaesthesia is still being debated. We performed a study to compare the effectiveness and safety of spinal anaesthesia with 12.5 mg of hyperbaric bupivacaine and a dosing regimen of conventional doses adjusted to parturient height. One hundred and forty parturients scheduled for elective CS were enrolled. The fixed-dose group (FD) received a spinal block with 12.5 mg of hyperbaric bupivacaine with fentanyl, whereas the adjusted-dose group (AD) received a height-adjusted dose of bupivacaine (9–13 mg) with fentanyl. Sensory block ≥ T5 dermatome within 10 min and no need for supplementary analgesia were set as the composite primary outcome (success). Rates of successful blocks and complications were compared. Complete data were available for 134 cases. Spinal anaesthesia was successful in 58 out of 67 patients in the FD group and 57 out of 67 in the AD group (p > 0.05). Eight spinals in each group failed to produce a block ≥ T5 in 10 min, and one patient in the FD group and two in the AD group required i.v. analgesics despite sensory block ≥ T5. No differences were noted in terms of hypotension, bradycardia and nausea between the FD and AD groups. Compared to the height-adjusted dose regimen based on conventional doses of hyperbaric bupivacaine, the fixed dose regimen of 12.5 mg was equally effective and did not increase the risk of spinal block-related complications.

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“…The researchers used Apgar score < 5 as a surrogate for HIE when assessing neonatal morbidity in infants born to obese mothers (27). This is pertinent to Rimsza et al's findings of increased anesthetic and surgical issues leading to decreased cord pH in women undergoing scheduled C-section, as previously mentioned (16). Chen and colleagues found no correlation with maternal obesity and Apgar score of <3 (28).…”

Section: Discussionmentioning

confidence: 72%

“…The most common neonatal problems associated with maternal obesity include macrosomia with a birthweight greater than four kilograms and hypoglycemia. Recently Rimsza et al published a study demonstrating lower umbilical arterial pH levels in obese women undergoing scheduled C-section, which was attributed to the influence of obesity on both spinal anesthesia placement and related hypotension, as well as slower time to delivery (16). This is highly concerning considering the increased rates of C-section in obese mothers.…”

Section: Introductionmentioning

confidence: 99%

“…Cnattingius et al as well as several other researchers have shown that obesity places the mother-infant dyad at an increased risk during pregnancy, delivery and postpartum (11,(16)(17)(18)(19)(20). The inability to reliably perform fetal monitoring and assess fetal wellbeing at an early stage compounds the increased risk to infants of obese mothers.…”

Section: Introductionmentioning

confidence: 99%

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Association of Maternal Obesity and Neonatal Hypoxic-Ischemic Encephalopathy

et al. 2022

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ObjectiveMore women are obese at their first prenatal visit and then subsequently gain further weight throughout pregnancy than ever before. The impact on the infant’s development of neonatal hypoxic ischemic encephalopathy (HIE) has not been well studied. Using defined physiologic and neurologic criteria, our primary aim was to determine if maternal obesity conferred an additional risk of HIE.Study DesignData from the New York State Perinatal Data System of all singleton, term births in the Northeastern New York region were reviewed using the NIH obesity definition (Body Mass Index (BMI) ≥ 30 kg/m2). Neurologic and physiologic parameters were used to make the diagnosis of HIE. Physiologic criteria included the presence of an acute perinatal event, 10-min Apgar score ≤ 5, and metabolic acidosis. Neurologic factors included hypotonia, abnormal reflexes, absent or weak suck, hyperalert, or irritable state or evidence of clinical seizures. Therapeutic hypothermia was initiated if the infant met HIE criteria when assessed by the medical team. Logistic regression analysis was used to assess the effect of maternal body mass index on the diagnosis of HIE.ResultsIn this large retrospective cohort study we evaluated outcomes of 97,488 pregnancies. Infants born to obese mothers were more likely to require ventilatory assistance and have a lower 5-min Apgar score. After adjusting for type of delivery and maternal risk factors, infants of obese mothers were diagnosed with HIE more frequently than infants of non-obese mothers, OR 1.96 (1.33–2.89) (p = 0.001).ConclusionInfants of obese mothers were significantly more likely to have the diagnosis of HIE.

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Time from neuraxial anesthesia placement to delivery is inversely proportional to umbilical arterial cord pH at scheduled cesarean delivery

Cited by 24 publications

References 21 publications

Association Between Obesity and Fetal Acidosis at Scheduled Cesarean Delivery

Association Between Obesity and Fetal Acidosis at Scheduled Cesarean Delivery

Fixed Dose versus Height-Adjusted Conventional Dose of Intrathecal Hyperbaric Bupivacaine for Caesarean Delivery: A Prospective, Double-Blinded Randomised Trial

Association of Maternal Obesity and Neonatal Hypoxic-Ischemic Encephalopathy

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