To Evaluate the Maternal and Foetal Outcome in Parturients Undergoing Caesarean Section for Pre-Eclampsia Under Spinal and General Anaesthesia: A Randomised Prospective Study
Abstract
Background: Pre-eclampsia has always been a challenge to the anaesthesiologist, in terms of choosing which type of anaesthesia to prefer. This present study was done to evaluate the maternal and foetal outcome in patients of caesarean section for pre-eclampsia under spinal and general anaesthesia.
Methods: This prospective study was conducted in 60 parturients, ASA 1 and 2 who underwent caesarean section for pre-eclampsia. These parturients were randomly and divided into two groups, Group S receiving spinal anesthesia and Group G receiving general anesthesia. For maternal outcome, the parturients were monitored for Blood Pressure, Heart Rate, Oxygen Saturation. Post-operative ICU admissions, convulsions, and pulmonary edema chances were seen. For fetal outcome, APGAR score was noted at 1 minute and 5 minutes after birth of child.
Results: The systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate were comparable in both the groups in the pre-operative period and at induction. However, intraoperatively, these parameters were significantly lower in the spinal anaesthesia group as compared to general anesthesia group (p<0.05). The Apgar Score was also found to be significantly higher in the newborns in spinal anaesthesia group as compared to general anaesthesia group. Post-operatively, more number of ICU admissions were seen in general anaesthesia group as compared to spinal anaesthesia group (p<0.05).
Conclusion: Spinal Anaesthesia can be considered as a first choice of anaesthesia in parturients undergoing caesarean section for preeclampsia with better hemodynamic control in intra-operative period and lesser chances of post-operative morbidity and mortality.
[2] Schneider MC, Landau R, Mortl MG. New insights in hypertensive disorders of pregnancy. Curr Opin Anaesthesiol. 2001; 14 (3): 291-7.
[3] Mackay AP, Berg CJ, Atrash H. Pregnancy-related mortality from pre-eclampsia and eclampsia. Obstet Gynecol. 2001; 97 (4): 533-8.
[4] Meis PJ, Goldenberg RL, Mercer BM, Iams JD, Moawad AH, Miodovnik M, et al. The preterm prediction study: risk factors for indicated preterm births: Maternal- Fetal Medicine Units Network of the National Institute of Child Health and Human Development. Am J Obstet Gynecol. 1998 Mar; 178(3):562-7
[5] Izci B, Riha RL, Martin SE, Vennelle M, Liston WA, Dundas KC, et al. The upper airway in pregnancy and pre-eclampsia. Am J Respir Crit Care Med. 2003; 167(2):137–40.
[6] Aya AGM, Vialles N, Tanoubi I, Mangin R, Ferrer JM, Robert C, et al. Spinal anesthesia-induced hypotension: A risk comparison between patients with severe preeclampsia and health women undergoing preterm cesarean delivery. Anesth Analg. 2005; 101(3):869–75.
[7] Azmude A, Agha'amou S, Yousefshahi F, Berjis K, Mirmohammad'khani M, Sadaat'ahmadi F, et al. Pregnancy outcome using general anesthesia versus spinal anesthesia for in vitro fertilization. Anesth Pain Med. 2013; 3(2):239–42.
[8] Chattopadhyay S, Das A, Pahari S. Fetomaternal outcome in severe preeclamptic women undergoing emergency cesarean section under either general or spinal anesthesia. J Pregnancy. 2014; 2014: 325098.
[9] Sivevski AG, Sholjakova MV, Kartalov AB, Kuzmanovska BK, Durnev VM, et al. Comparison of low dose spinal anaesthesia with general anaesthesia in pre-eclamptic parturients undergoing emergency caesarean section. Anaesthesia Pain and Intensive Care. 2015; 19:37-43.
[10] Christopher M.A. et. al. Analysis of maternal and fetal outcome in spinal versus epidural anaesthesia for caesarean delivery in pre-eclampsia. Journal of Evidence Based Healthc 2015; 2(60), 9023-9.
[11] Alnour TM, Shaktur AT, Ayyad RA, Alhewat MM, Shaban EH, et al. Comparison between the Side Effects of Spinal and General Anaesthesia during Caesarean Section in Tripoli-Libya. Journal of Anesthesia and Clinical Research. 2015; 6: 560.
[12] Nikooseresht M, et. al. Comparing the Hemodynamic Effects of Spinal Anesthesia in Preeclamptic and Healthy Parturients During Cesarean Section. Anesth Pain Med. 2016; 6(3): e11519.
[13] Ravi T, Kumar, N. & Raju, K. Analysis of maternal outcome of general versus spinal anaesthesia for caesarean delivery in severe pre-eclampsia. Asian Pacific Journal of Health Sciences. 2016; 3. 101-7.
[14] Aregawi A, Terefe T, Admasu W, Akalu L. Comparing the Effect of Spinal and General Anaesthesia for Pre-Eclamptic Mothers Who Underwent Caesarean Delivery in Black Lion Specialized Hospital, Addis Ababa, Ethiopia. Ethiop J Health Sci. 2018; 28 (4):443-50.
[15] Dutta Obstetrics 8th Edition, chapter 18, Hypertensive disorders in pregnancy. p255-80.
[16] Mandai NG, Surapaneni S. Regional Anaesthesia in pre-eclampsia: advantages and disadvantages. Drugs. 2004; 64(3):223-36.
[17] Bajwa SJ, Bajwa SK. Anaesthetic challenges and management during pregnancy: Strategies revisited. Anesth Essays Res. 2013;7(2):160-7.
[18] Parks textbook of preventive and social medicine, 23rd Edition. p532-3.
[19] Dasgupta S, Chakraborty B, Saha D, Ghosh D. Comparison of neonatal outcome in women with severe pre-eclampsia undergoing caesarean section under spinal or general anaesthesia. J Indian Med Assoc. 2011;109(3):166-70.
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Issue | Vol 9 No 4 (2023): Autumn | |
Section | Research Article(s) | |
DOI | https://doi.org/10.18502/aacc.v9i4.13520 | |
Keywords | ||
pre-eclampsia general anaesthesia spinal anaesthesia newborn Apgar score caesarean. |
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