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Research Article
General Versus Regional Anaesthesia for Caesarean Section Indicated for Acute Foetal Distress: A Retrospective Cohort Study
Emelinda Nyuydzefon
Université de Yaoundé I
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Acute foetal distress (AFD) is a life-threatening foetal condition complicating 2% of all pregnancies and accounting for 8.9% of caesarean sections (CS) especially in developing nations. Despite the severity of the problem, no evidence exists as to the safest anaesthetic technique for the mother and foetus couple undergoing CS for AFD. We aimed to compare general anaesthesia (GA) versus regional (spinal and epidural) anaesthesia in terms of their perioperative maternal and foetal outcomes.
Methods
We carried out a retrospective cohort study by reviewing the medical records of all women who underwent CS indicated for AFD between 2015 to 2018 at the Douala General Hospital, Cameroon. Medical records of neonates were also reviewed. We sought to investigate the association between GA, and regional anaesthesia administered during CS for AFD and foetal and maternal outcomes. The threshold of statistical significance was set at 0.05.
Results
We enrolled the medical records of 117 pregnant women who underwent CS indicated for AFD. Their mean age and mean gestational age were 30.5 ± 4.8 years and 40 weeks respectively. Eighty-three (70.9%), 29 (24.8%) and 05 (4.3%) pregnant women underwent CS under SA, GA and EA respectively. Neonates delivered by CS under GA were more likely to have a significantly low APGAR score at both the 1st (RR = 1.93, p = 0.014) and third-minute (RR = 2.52, p = 0.012) and to be resuscitated at birth (RR = 2.15, p = 0.015).Past CS, FHR pattern on CTG didn’t affect these results in multivariate analysis. Adverse maternal outcomes are shown to be higher following SA when compared to GA
Conclusion
The study infers an association between CS performed for AFD under GA and fetal morbidity. This, however, failed to translate into a difference in perinatal mortality when comparing GA vs RA. This finding does not discount the role of GA, but we emphasize the need for specific precautions like adequate anticipation for neonatal resuscitation in order to reduce neonatal complications associated with CS performed for AFD under GA.
Keywords
acute foetal distress, caesarean section, anaesthesia, neonatal, maternal, outcome
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CURRENT STATUS: Under Revision
Version 1
Posted 29 Dec, 2020
No community comments so far
Editorial decision: Major revision
On 19 Jan, 2021
Review #7 received
Received 29 Dec, 2020
Review #4 received
Received 29 Dec, 2020
Review #5 received
Received 29 Dec, 2020
Review #9 received
Received 29 Dec, 2020
Review #1 received
Received 29 Dec, 2020
Review #2 received
Received 29 Dec, 2020
Review #3 received
Received 29 Dec, 2020
Review #6 received
Received 29 Dec, 2020
Review #8 received
Received 29 Dec, 2020
Reviewer #9 agreed
On 28 Dec, 2020
Reviewer #6 agreed
On 28 Dec, 2020
Reviewer #7 agreed
On 28 Dec, 2020
Reviewer #11 agreed
On 28 Dec, 2020
Reviewer #3 agreed
On 28 Dec, 2020
Reviewer #2 agreed
On 28 Dec, 2020
Reviewer #4 agreed
On 28 Dec, 2020
Reviewer #5 agreed
On 28 Dec, 2020
Reviewer #8 agreed
On 28 Dec, 2020
Reviewer #1 agreed
On 28 Dec, 2020
Reviewer #10 agreed
On 28 Dec, 2020
Reviewers invited
Invitations sent on 28 Dec, 2020
Editor assigned
On 28 Dec, 2020
Editor invited
On 27 Dec, 2020
Submission checks complete
On 27 Dec, 2020
First submitted
On 11 Dec, 2020
Metrics
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PDF Downloads: ...
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Subject Areas
Anesthesiology & Pain Medicine
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This preprint is under consideration at BMC Anesthesiology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
General Versus Regional Anaesthesia for Caesarean Section Indicated for Acute Foetal Distress: A Retrospective Cohort Study
Emelinda Nyuydzefon
Université de Yaoundé I
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Version 1
Posted 29 Dec, 2020
No community comments so far
Editorial decision: Major revision
On 19 Jan, 2021
Review #7 received
Received 29 Dec, 2020
Review #4 received
Received 29 Dec, 2020
Review #5 received
Received 29 Dec, 2020
Review #9 received
Received 29 Dec, 2020
Review #1 received
Received 29 Dec, 2020
Review #2 received
Received 29 Dec, 2020
Review #3 received
Received 29 Dec, 2020
Review #6 received
Received 29 Dec, 2020
Review #8 received
Received 29 Dec, 2020
Reviewer #9 agreed
On 28 Dec, 2020
Reviewer #6 agreed
On 28 Dec, 2020
Reviewer #7 agreed
On 28 Dec, 2020
Reviewer #11 agreed
On 28 Dec, 2020
Reviewer #3 agreed
On 28 Dec, 2020
Reviewer #2 agreed
On 28 Dec, 2020
Reviewer #4 agreed
On 28 Dec, 2020
Reviewer #5 agreed
On 28 Dec, 2020
Reviewer #8 agreed
On 28 Dec, 2020
Reviewer #1 agreed
On 28 Dec, 2020
Reviewer #10 agreed
On 28 Dec, 2020
Reviewers invited
Invitations sent on 28 Dec, 2020
Editor assigned
On 28 Dec, 2020
Editor invited
On 27 Dec, 2020
Submission checks complete
On 27 Dec, 2020
First submitted
On 11 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Acute foetal distress (AFD) is a life-threatening foetal condition complicating 2% of all pregnancies and accounting for 8.9% of caesarean sections (CS) especially in developing nations. Despite the severity of the problem, no evidence exists as to the safest anaesthetic technique for the mother and foetus couple undergoing CS for AFD. We aimed to compare general anaesthesia (GA) versus regional (spinal and epidural) anaesthesia in terms of their perioperative maternal and foetal outcomes.
Methods
We carried out a retrospective cohort study by reviewing the medical records of all women who underwent CS indicated for AFD between 2015 to 2018 at the Douala General Hospital, Cameroon. Medical records of neonates were also reviewed. We sought to investigate the association between GA, and regional anaesthesia administered during CS for AFD and foetal and maternal outcomes. The threshold of statistical significance was set at 0.05.
Results
We enrolled the medical records of 117 pregnant women who underwent CS indicated for AFD. Their mean age and mean gestational age were 30.5 ± 4.8 years and 40 weeks respectively. Eighty-three (70.9%), 29 (24.8%) and 05 (4.3%) pregnant women underwent CS under SA, GA and EA respectively. Neonates delivered by CS under GA were more likely to have a significantly low APGAR score at both the 1st (RR = 1.93, p = 0.014) and third-minute (RR = 2.52, p = 0.012) and to be resuscitated at birth (RR = 2.15, p = 0.015).Past CS, FHR pattern on CTG didn’t affect these results in multivariate analysis. Adverse maternal outcomes are shown to be higher following SA when compared to GA
Conclusion
The study infers an association between CS performed for AFD under GA and fetal morbidity. This, however, failed to translate into a difference in perinatal mortality when comparing GA vs RA. This finding does not discount the role of GA, but we emphasize the need for specific precautions like adequate anticipation for neonatal resuscitation in order to reduce neonatal complications associated with CS performed for AFD under GA.