Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial

The impact of general anesthesia on the outcomes of preterm infants with gestational age less than 32 weeks delivered via cesarean section

Background

Recent advancements in China's perinatal and neonatal intensive care have significantly reduced neonatal mortality, yet preterm births before 32 weeks remain the primary cause of neonatal fatalities and contribute to long-term disabilities. The prognosis of very preterm infants (VPIs) is significantly affected by factors including the intrauterine environment, delivery method and neonatal intensive care. Cesarean section which often used for preterm births has implications that are not fully understood, particularly concerning the type of anesthesia used. This study examines the impact of general anesthesia (GA) during cesarean delivery on VPI outcomes, aiming to identify strategies for mitigating GA-associated risks.

Methods

This cohort study analyzed 1,029 VPIs born via cesarean section under 32 weeks' gestation at our single-center from 1 January 2018, to 31 December 2022. Detailed medical records, encompassing perioperative information, maternal data and neonatal outcomes were meticulously examined. The primary aim of this investigation was to compare maternal characteristics and neonatal outcomes between VPIs delivered under GA and neuraxial anesthesia (NA). A significance level of p < 0.05 was established.

Results

Of the 1,029 VPIs analyzed, 87.95% (n = 905) were delivered via NA and 12.05% (n = 124) via GA. Mothers with hypertensive pregnancy diseases and emergency operations were more inclined to choose GA. VPIs delivered under GA showed a lower Apgar score at one and 5 minutes (p < 0.01), increased need for tracheal intubation resuscitation (32.2% vs. 12.2%, p < 0.01) and a greater incidence of severe neurological injury (SNI) (14.5% vs. 5%, p < 0.01). Multivariable analysis revealed GA was significantly associated with lower Apgar scores at one (OR 6.321, 95% CI 3.729-10.714; p < 0.01) and 5 minutes (OR 4.535, 95% CI 2.975-6.913; p < 0.01), higher risk of tracheal intubation resuscitation (OR = 3.133, 95% CI = 1.939-5.061; p < 0.01) and SNI (OR = 3.019, 95% CI = 1.615-5.643; p < 0.01). Furthermore, for VPIs delivered under GA, a prolonged interval from skin incision to fetus delivery was associated with a lower 5-min Apgar score (p < 0.01).

Conclusion

This study revealed the significant impact of GA on adverse outcomes among VPIs. In cases when GA is required, proactive measures should be instituted for the care of VPIs such as expediting the interval from skin incision to fetal delivery.

Comparison of the Effects of Anaesthesia Methods Used in Caesarean Delivery on Neonatal Cerebral and Renal Oxygenation: A Randomised Controlled Trial

Background: During a newborn's adaptation to extrauterine life, many changes take place that are influenced by various factors. The type of delivery and anaesthesia strategy utilised during labour can modify these adaptive modifications. In this regard, this study was designed to compare the effects of general and spinal anaesthesia on cerebral and renal oxygenation after elective caesarean deliveries. Methods: This randomised controlled study comprised sixty parturient women who were over 18 years old and had a gestational age between 37 and 41 weeks. All participants had an ASA (American Society of Anesthesiologists) classification of II. Neonatal cerebral (CrSO2) and renal (RrSO2) regional oxygen saturations were assessed using near-infrared spectroscopy. Additionally, the 1st-5th min Apgar scores, preductal and postductal peripheral oxygen saturation (SpO2), and perfusion index were recorded in both the general anaesthesia and spinal anaesthesia groups. Results: There was no statistically significant difference between the two groups in terms of CrSO2 or RrSO2 values. The values of CrSO2 and RrSO2 in both groups showed a significant rise from the 10th to the 15th min, respectively. Conclusions: General and spinal anaesthesia techniques used for cesarean delivery have similar effects on neonatal cerebral and renal oxygenation.

Effect of anesthesia type on outcome measures in cesarean section in the presence of fetal macrosomia

OBJECTIVE:

The aim of this study was to compare the effects of general and spinal anesthesia on maternal and neonatal outcomes during cesarean section in pregnancies with macrosomia.

METHODS:

This retrospective cohort study included 1043 patients who delivered by cesarean section between May 2018 and December 2021 and had a baby born with a birth weight of 4000 g or greater. Maternal and neonatal outcomes were compared according to the type of anesthesia performed in the spinal anesthesia group (n=903; 86.6%) and general anesthesia group (n=140; 13.4%). The Apgar score was categorized into <7 and ≥7.

RESULTS:

Neonates with an Apgar score of <7 at the first minute (11.4 vs. 0.4%; p<0.001) and the fifth minute (2.9 vs. 0.3%; p=0.004) were significantly higher in the general anesthesia group. The preoperative and postoperative hematocrit difference was significantly lower in patients who received spinal anesthesia than those who received general anesthesia [2 (1.1–3.1) vs. 4.05 (2.8–5.35); p<0.001]. The number of patients transfused was higher in the general anesthesia group (9.3 vs. 2.7%; p<0.001). In the regression model, general anesthesia, birth weight, and emergency conditions were significant independent factors related to the preoperative and postoperative hematocrit decrease (p<0.001, p=0.005, and p=0.034, respectively).

CONCLUSIONS:

Apgar scores of <7 at the first and fifth minutes are higher in macrosomic neonates who received general anesthesia than in neonates who received spinal anesthesia. Performing cesarean section under general anesthesia in mothers of macrosomic neonates results in a greater decrease in hematocrit value and a greater need for blood transfusion than under spinal anesthesia.

Effect of Prophylactic Intrathecal Pethidine on the Incidence of Shivering on Mothers Undergoing Cesarean Section Under Spinal Anesthesia: A Randomized Controlled Trial

Background

Shivering is the most common and unpleasant complication of anesthesia with an incidence of 70.7% in cesarean section done under spinal anesthesia which is associated with cardiovascular and respiratory complications. Even though it causes such devastating complications; the prevention of shivering is not well investigated. This study aimed to assess the effect of intrathecal pethidine on the incidence and severity of shivering in patients undergoing cesarean section under Spinal anesthesia.

Materials and Methods

After obtaining ethical clearance double-blinded single centered a randomized controlled trial was conducted in a total of 86 pregnant mothers who were randomly allocated into two groups by computer-generated random number. Approximately 1 ml of 10 mg preservative-free pethidine was added to 12.5 mg of 0.5% bupivacaine for spinal anesthesia in the treatment group and 12.5 mg of 0.5% bupivacaine alone was given in the control group. Incidence and severity of shivering, as well as adverse effect was recorded intraoperatively, in post-anesthesia care unit (PACU) and ward. Independent sample t-test, Mann–Whitney U test and chi-square were used for analysis. A p-value less than 0.05 was considered statistically significant.

Results

Shivering was observed in 53.5 and 20.9% in the control and treatment groups, respectively, which was statistically significant with p = 0.002. The risk of developing shivering was reduced by 61% in the treatment group with (RR = 0.39 and CI of 0.205–0.745); the intensity of shivering was also higher in the control group than in the treatment group with p = 0.004. Considering an adverse effect, the incidence of PONV was not significantly different between with p &gt; 0.05 while the incidence of pruritus was higher in the treatment group than the control group with p = 0.003.

Conclusion

Adding 10 mg of preservative free pethidine intrathecally during spinal anesthesia is effective in reducing incidence and severity of shivering, without causing significant adverse effects on mother.

Duration of Exposure to General Endotracheal Anesthesia during Cesarean Deliveries at Term and Perinatal Complications

OBJECTIVE

To examine whether the duration of time from initiation of general endotracheal anesthesia (GETA) to delivery for cesarean deliveries (CDs) performed is related to perinatal outcomes.

STUDY DESIGN

This is a retrospective study of patients with singleton nonanomalous gestations undergoing CD ≥37 weeks of gestation under GETA with reassuring fetal status at a single tertiary care center from 2000 to 2016. Duration from GETA initiation until delivery was calculated as the time interval from GETA induction to delivery (I-D), categorized into tertiles. Outcomes for those in the tertile with the shortest I-D were compared with those in the other two tertiles. The primary perinatal outcome was a composite of complications (continuous positive airway pressure or high-flow nasal cannula for ≥2 consecutive hours, inspired oxygen ≥30% for ≥4 consecutive hours, mechanical ventilation, stillbirth, or neonatal death ≤72 hours after birth). Secondary outcomes were 5-minute Apgar score <7 and a composite of maternal morbidity (bladder injury, bowel injury, and extension of hysterotomy). Bivariable and multivariable analyses were used to compare outcomes.

RESULTS

Two hundred eighteen maternal-perinatal dyads were analyzed. They were dichotomized based on I-D ≤4 minutes (those in the tertile with the shortest duration) or >4 minutes. Women with I-D >4 minutes were more likely to have prior abdominal surgery and less likely to have labored prior to CD. I-D >4 minutes was associated with significantly increased frequency of the primary perinatal outcome. This persisted after multivariable adjustment. In bivariable analysis, 5-minute Apgar <7 was more common in the group with I-D >4 minutes, but this did not persist in multivariable analysis. Frequency of maternal morbidity did not differ.

CONCLUSION

When CD is performed at term using GETA without evidence of nonreassuring fetal status prior to delivery, I-D interval >4 minutes is associated with increased frequency of perinatal complications.

KEY POINTS

· Cesarean delivery under general anesthesia is associated with increased perinatal complications.. · Perinatal complications are increased with increasing duration of exposure to general anesthetics.. · Maternal complications were not increased with shorter duration of exposure to general anesthesia..

Predictors of immediate neonatal outcome after cesarean section in Uganda

OBJECTIVE

To identify predictors of low Apgar score, immediate neonatal death, and stillbirth after cesarean section in Uganda.

METHODS

Records of cesarean sections performed at all 14 regional referral hospitals and also 14 first-level (district) hospitals in Uganda were reviewed. Both elective and emergency cases were included. Data comprised mother's age, indication, type of anesthesia, and immediate outcome of the newborn. To evaluate the relation of the predictor variables to outcome, regression analysis was performed.

RESULTS

A total of 37 585 cesarean sections were recorded. The indications for cesarean section that led to the highest neonatal mortality and stillbirth rates and lowest mean Apgar scores were uterine rupture and hemorrhage. Emergency surgery and general anesthesia had worse neonatal outcomes than elective surgery and spinal anesthesia. Compared with general anesthesia, spinal anesthesia was favorable for neonatal outcomes.

CONCLUSION

Elective surgical planning and scale-up of the use of spinal anesthesia may potentially reduce stillbirths and immediate neonatal deaths.

A systematic review with network meta-analysis on mono strategy of anaesthesia for preeclampsia in caesarean section

The aim of this study was to reveal the effects of anaesthesia strategies on maternal mean arterial pressure (MAP), heart rate, vasopressor consumption, adverse events, and neonatal resuscitation when women with preeclampsia (PE) undergo caesarean section (CS). Three major databases were searched for randomized controlled trials (RCTs) and prospective controlled studies (PCSs). Two authors independently screened, extracted, and checked eligibility and outcome data. Outcomes involved MAP, vasopressor use, maternal adverse events, APGAR scores, and neonatal resuscitation. Pooled estimates were carried out by contrast-based network meta-analysis, and pooled effect sizes were presented with 95% confidence interval (CI). Eleven RCTs and one PCS (n = 782) formed three-node network meta-analysis, and non-significant differences were observed in MAP, 5-min APGAR score, and neonatal intubation rate among the three anaesthesia strategies. General anaesthesia had significantly lower vasopressor consumption than spinal anaesthesia did (standardised mean difference =  - 1.19, 95% confidence interval [CI]: - 1.76 to - 0.63), but it had higher maternal adverse event rate (risk ratio = 2.00, 95% CI 1.16-3.47). Because no optimal anaesthesia strategy has been shown to achieve a balanced maternal and neonatal outcome, therefore a shared decision-making process may be required regarding the most suitable choice of anaesthetic strategy for individual preeclamptic mother undergoing CS. Future larger studies may need to focus on evaluating the role of vasopressors on maternal hemodynamic as well as factors affecting maternal outcomes for different anaesthetic techniques in preeclamptic women undergoing CS.

Comparison of the effect of general and spinal anesthesia for elective cesarean section on maternal and fetal outcomes: a retrospective cohort study

Background

Anesthesia is needed to ensure both maternal and fetal safety during cesarean sections. This retrospective cohort study compared maternal and fetal outcomes between general and spinal anesthesia for cesarean section based on perioperative hemodynamic parameters (pre- and postoperative systolic blood pressure, heart rate), mean difference of hematocrit and estimated blood loss, and neonatal Apgar scores at 1 and 5 min.

Methods

Data from electronic medical records of 331 singleton pregnancies between January 2016 and December 2018 were analyzed retrospectively; 44 cases were excluded, and 287 cases were assigned to the general group (n = 141) or spinal group (n = 146).

Results

Postoperative hemodynamic parameters were significantly higher in the general group than the spinal group (systolic blood pressure: 136.8 ± 16.7 vs. 119.3 ± 12.7 mmHg, heart rate: 93.2 ± 16.8 vs. 71.0 ± 12.7 beats/min, respectively, P < 0.001). The mean difference between the pre- and postoperative hematocrit was also significantly greater in the general than spinal group (4.8 ± 3.4% vs. 2.3 ± 3.9%, respectively, P < 0.001). The estimated blood loss was significantly lower in the spinal than general group (819.9 ± 81.9 vs. 856.7 ± 117.9 ml, P < 0.001). There was a significantly larger proportion of newborns with 5-min Apgar scores < 7 in the general than spinal group (6/141 [4.3%] vs. 0/146 [0%], respectively, P = 0.012).

Conclusions

General group is associated with more maternal blood loss and a larger proportion of newborns with 5-min Apgar scores < 7 than spinal group during cesarean sections.

Comparison of Effects of General Anesthesia and Combined Spinal/Epidural Anesthesia for Cesarean Delivery on Umbilical Cord Blood Gas Values: A Double-Blind, Randomized, Controlled Study

BACKGROUND The objective of this study was to analyze the effects of general anesthesia in cesarean section on the umbilical cord blood gas values and intraoperative hemodynamics of parturient women. MATERIAL AND METHODS A total of 112 parturient women who received cesarean section were eventually randomized into 2 groups, GA (general anesthesia) group (n=56), and SE (combined spinal and epidural anesthesia) group (n=56). The umbilical cord blood gas values, postpartum Apgar score, intraoperative blood loss, mean arterial pressure, heart rate, total operative time, time intervals from anesthesia to delivery and from skin incision to delivery, the incidences of adverse reactions and neonatal asphyxia, and the postoperative patient satisfaction were compared between the 2 groups. RESULTS There were no significant differences between the 2 groups in total operative time, Apgar score, neonatal asphyxia rate, umbilical arterial and venous cord blood gas values, intraoperative blood loss, and time interval from skin incision to delivery (all P˃0.05). The GA group was significantly shorter in the time interval from anesthesia to delivery than the SE group (P˂0.05). The incidences of nausea, vomiting, and chills in the GA group were significantly lower than those in the SE group (all P˂0.05). The GA group was significantly higher in postoperative patient satisfaction than the SE group (P˂0.05). CONCLUSIONS General anesthesia has little impact on the umbilical cord blood gas values and Apgar score, and ensures better hemodynamic stability in cesarean section. Moreover, general anesthesia is characterized by rapid induction and is therefore valuable for use in clinical procedures.

Comparing the Effect of Spinal and General Anaesthesia for Pre-Eclamptic Mothers Who Underwent Caesarean Delivery in A Tertiary, Addis Ababa, Ethiopia

Background

Opinions are controversial regarding the use of general and spinal anesthesia in pre-eclamptic mothers undergoing Caesarean section. Some studies recommended avoiding spinal anesthesia in pre-eclamptic patients because of concern for sudden severe hypotension, while other studies support the use of spinal anesthesia as first choice reasoning less post-operative morbidity and mortality. This study aims to compare maternal outcome among pre-eclamptic women undergone caesarian delivery under general and spinal anesthesia.

Methods and Patients

A retrospective comparative cross-sectional study was conducted to compare maternal outcome. All pre-eclamptic mothers who underwent Caesarian section in Black Lion Specialized Hospital from October 2014 to October 2016 were included in the study. Data entry and analysis were conducted using SPSS version 20. Student's T-test was used to compare the outcome in both groups and p value < 0.05 was set as cut off point for statistical significance.

Results

A total of 170 client documents were reviewed. The mean age of the study subjects was 28.18 ± 4.66 years, with median age 28 years (IQR: 25–30). Our study shows that both general and spinal anesthesia have no difference in terms of maternal survival status, days of hospital stay, post-operative admission to ICU, and post-operative complications. However, this study found a statistically significant higher post-operative blood pressure and pulse rate among general anesthesia groups compared with spinal anesthesia group.

Conclusion

Spinal anesthesia is safer than general anesthesia in terms of stable vital signs among pre-eclamptic women undergoing Cesarean section.

Cerebral Oxygenation in Neonates Immediately after Cesarean Section and Mode of Maternal Anesthesia

BACKGROUND

Cerebral regional oxygen saturation (crSO2) during immediate transition and resuscitation immediately after birth is of increasing interest.

OBJECTIVES

The aim of the present study was to assess whether the type of maternal anesthesia during cesarean section (CS; general anesthesia vs. spinal anesthesia) has an influence on cerebral oxygenation during immediate neonatal transition after birth.

METHODS

Secondary outcome parameters of prospective observational studies were analyzed. Neonates born by CS from November 2009 to September 2016 at the Medical University of Graz (Austria) were eligible. Term and preterm neonates were included, provided that: (1) crSO2 was measured by near-infrared spectroscopy, and (2) peripheral arterial oxygen saturation (SpO2) and heart rate (HR) were measured by pulse oximetry during the first 15 min after birth. Administration of supplemental oxygen was recorded and cerebral fractional tissue oxygen extraction (cFTOE) was calculated out of crSO2 and SpO2. For comparison, term and preterm neonates with maternal general anesthesia were matched to neonates with maternal spinal anesthesia during CS.

RESULTS

Out of 760 eligible neonates, 64 term (38.8 ± 0.9 weeks of gestation; 32 neonates in each group) and 54 preterm neonates (32.0 ± 2.9 weeks of gestation; 27 neonates in each group) were included. In term neonates, maternal general anesthesia was associated with lower initial SpO2, HR values, and Apgar scores. The fraction of inspired oxygen (FiO2) was statistically significantly higher in the general anesthesia group. Nevertheless, crSO2 and cFTOE did not differ statistically significantly between the groups. In preterm neonates there were no statistically significant differences in SpO2, HR, crSO2, and cFTOE between the general and spinal anesthesia groups. Apgar scores at 1 min were statistically significantly lower and FiO2 was statistically significantly higher in the general anesthesia group.

CONCLUSION

Cerebral tissue oxygenation in neonates during immediate transition after birth was similar after maternal general and spinal anesthesia during CS, despite differences in SpO2, HR, and supplemental oxygen in term neonates and differences in supplemental oxygen in preterm neonates.

Effect of anaesthetic technique on neonatal morbidity in emergency caesarean section for foetal distress

Background

While foetal distress is typically associated with ischaemic injury, few studies have assessed neonatal morbidity for emergency caesarean section. Moreover, the decision of the anaesthetic technique may be of paramount importance in emergency caesareans, because of the limited time and increased risk. We aimed to evaluate the effect of the anaesthetic technique on neonatal morbidity in emergency caesarean indicated for foetal distress.

Methods

This was a single-centre, prospective observational study, conducted between July-2015 and December-2015. The study enrolled parturient with indication for emergency caesarean section after diagnosis of foetal distress, who received either regional or general anaesthesia. The outcome measures were: 1, 5-minute Apgar scores; umbilical blood pH; length of hospitalization; and morbidity, defined as a 5-minute Apgar score <7, need for mechanical ventilation, admittance to a neonatal intensive care unit, or respiratory insufficiency symptoms.

Results

61 patients were included in the study, of whom 31 received regional anaesthesia. Neonatal morbidity was noted in 5 and 9 cases with regional and general anaesthesia, respectively. The 1-minute Apgar score was significantly lower(p = 0,045) for cases with general anaesthesia, which was not true for the 5-minute Apgar score. Regional anaesthesia was non-significantly associated with shorter length of hospitalization, lower incidence of morbidity, and higher umbilical blood pH. When we take regional anaesthesia cases as a reference point, we detected that general anaesthesia cases are showing 2,2 times more morbidity risk. But these results did not reach any statistically significant levels.

Conclusions

While we did find some improved results for regional anaesthesia group, we found no statistical evidence that neither anaesthesia technique is superior regarding neonatal morbidity. We think that regional anaesthesia should be preferred whenever possible because of our improved results of length of hospital stay, APGAR and morbidity and we think that general anaesthesia is indicated for very urgent cases or regional anaesthesia contraindicated patients.

Trial registration

http://www.isrctn.com/ISRCTN15181117

[Risk factors for maternal and perinatal mortality among women undergoing cesarean section in Lubumbashi, Democratic Republic of Congo II]

Introduction

L’objectif était d’analyser les facteurs de risque de mortalité maternelle et périnatale de la césarienne à Lubumbashi, République Démocratique du Congo (RDC).

Méthodes

Étude multicentrique de 3643 césariennes réalisées entre le 1er janvier 2009 et le 31 décembre 2013 sur un total de 34199 accouchements dans cinq formations hospitalières de référence à Lubumbashi (RDC). Les données sociodémographiques, les indications, l’environnement obstétrical et la morbi-mortalité maternelles et périnatales ont été analysés au logiciel Epi Info 2011. Les fréquences calculées sont exprimées en pourcentage et les moyennes avec leurs écart-types. Le test de Chi-carré et le test exact de Fisher lorsque recommandés ont été utilisés pour la comparaison des fréquences. L’odds ratio a été calculé avec l’intervalle de confiance de 95% de Cornfield grâce à un modèle de régression logistique pour déterminer la puissance de facteurs de risque. Le seuil de signification a été fixé à p < 0,05.

Résultats

La fréquence de la césarienne était de 10,65%. L'âge moyen des césarisées était de 28,83±6,8 ans (extrêmes: 14 et 49 ans). La parité variait de 1 à 16 avec une moyenne de 2,6. De ces opérées, une sur neuf (10,9%) était porteuse d’un utérus cicatriciel de césarienne antérieure et 22,3% étaient des évacuées obstétricales. Les taux de létalité maternelle et périnatale étaient respectivement de 1,4% et 7,07% lors de la césarienne. L’analyse des facteurs de risque montre que la grande multiparité (≥5), l’absence de surveillance de la grossesse, le caractère urgent de l’indication opératoire influent significativement sur la mortalité maternelle. A ces facteurs s’ajoutent pour la mortalité périnatale l’âge maternel avancé (> 35 ans), l’évacuation comme mode d’admission et l’immaturité fœtale.

Conclusion

Cette étude montre que la césarienne dans nos conditions de travail est couplée à une forte mortalité maternelle et périnatale. Les facteurs de risque identifiés sont en grande partie évitables, surtout à tort ou à raison imputés à l’opération masquant ipso facto les circonstances souvent irrationnelles de sa pratique.

Introduction

The objective was to analyze risk factors for maternal and perinatal mortality among women undergoing cesarean section in Lubumbashi, Democratic Republic of Congo (DRC).

Methods

We conducted a multicenter study of 3643 women undergoing cesarean sections between 1 January 2009 and 31 December 2013 out of 34199 women delivering in five general referral hospitals in Lubumbashi (DRC). Sociodemographic data, indications, obstetrical environment as well as maternal and perinatal morbi-mortality were analyzed using Epi Info 2011 software. Computed frequencies were expressed in percentage and mean values were expressed in terms of standard deviations. Chi-square test and Fisher’s exact test, when recommended, were used to compare frequencies. The odds ratio was calculated using Cornfield 95% confidence interval based on a logistic regression model in order to determine the strength of risk factors. Threshold significance level was set at p < 0.05.

Results

The frequency of cesarean sections was 10.65%. The average age of women undergoing cesarean section was 28.83 ± 6.8 years (with a range from 14 to 49 years). Parity ranged from 1 to 16 with an average of 2.6. 1 out of 9 (10.9%) women undergoing cesarean section were patients with previous caesarean section uterine scar on the anterior wall of the uterus and 22.3% of women were patients with previous obstetric evaquation. Maternal and perinatal mortality rate was 1.4% and 7.07% during cesarean section respectively. The analysis of risk factors shows that the great multiparity (≥5), the absence of monitoring during pregnancy, the urgent nature of emergency surgery significantly affect maternal mortality. Other factors for perinatal mortality included advanced maternal age (>35 years), patients referral from one facility to another as a mode of admission and fetal immaturity.

Conclusion

This study shows that cesarean section in our working condition is associated to a significant maternal and perinatal mortality. Identified risk factors are largely preventable, because they are rightly or wrongly ascribed to cesarean section glossing over, ipso facto, the often irrational circumstances of its practice.

Prediction of intraoperative nausea and vomiting in caesarean delivery under regional anaesthesia

Objectives

This study aimed to predict patients who have caesarean operations under regional anaesthesia and are at risk for intraoperative nausea and vomiting (IONV), for ultimately prompting anaesthetists and surgeons to take preventive measures.

Methods

This was a retrospective study on 209 patients who had caesarean section under spinal-epidural combined regional anaesthesia. The relevant medical history, such as severe nausea and vomiting in the first trimester, smoking, a history of motion sickness, and premenstrual syndrome (PMS), were obtained from the patients’ records and interviews.

Results

Patients who had a female neonate, a history of severe nausea and vomiting in the first trimester, and a history of PMS and motion sickness before pregnancy experienced a significantly higher rate of IONV. Smokers were less susceptible to IONV, but this was not significant.

Conclusion

This study shows that some factors in the medical history of a patient can help identify those who are more likely to suffer from IONV.