Associated factors with umbilical arterial pH after cesarean delivery under spinal anesthesia: a retrospective cohort study
Fatores associados ao pH arterial umbilical após parto cesáreo sob raquianestesia: um estudo de coorte retrospectivo
Miwa Kitaguchi, Mitsuru Ida, Yusuke Naito, Yuka Akasaki, Masahiko Kawaguchi
Abstract
Background
Maximum decrease of blood pressure and number of minutes of hypotension were independently associated with umbilical arterial pH. However, the impact of hypotension considering the duration of it on umbilical arterial pH is unknown.
Methods
Pregnant women aged ≥ 20 years who delivered a baby at full-term via a cesarean delivery under a single-shot spinal anesthesia between January 2017 and March 2019 were included. The main outcome was to predict umbilical arterial pH, based on the value of the time integral of hypotension. Patient demographics, patient comorbidities, and intraoperative data, including the total dose of ephedrine and phenylephrine by fetal delivery and cumulative duration of maternal hypotension, were evaluated. Maternal hypotension was reflected as a decrease in systolic arterial pressure and mean arterial pressure to < 80% of baseline values. The systolic arterial pressure and mean arterial pressure were independently included in a multiple regression analysis along with all other explanatory factors to predict the umbilical arterial pH.
Results
Of the 416 eligible patients, 381 were enrolled. When including the systolic arterial pressure or mean arterial pressure in the model, emergency cases, the total dose of ephedrine, hypertensive disorders of pregnancy, and systolic arterial pressure or mean arterial pressure values were found to be significant predictive factors of umbilical arterial pH.
Conclusion
Our results suggest that an elevated time integral of maternal hypotension may have a negative impact on umbilical arterial pH. Therefore, to minimize the risk of fetal acidosis, maternal hypotension should be prevented with the consideration of vasopressors selection.
Keywords
Resumo
Justificativa: A diminuição máxima da pressão arterial e o número de minutos de hipotensão foram independentemente associados ao pH arterial umbilical. No entanto, o impacto da hipotensão considerando sua duração no pH arterial umbilical é desconhecido. Métodos: Foram incluídas gestantes com idade ≥ 20 anos que deram à luz a termo por cesariana sob raquianestesia única entre janeiro de 2017 e março de 2019. O principal desfecho foi prever o pH arterial umbilical, com base no valor da integral do tempo de hipotensão. Dados demográficos do paciente, comorbidades do paciente e dados intraoperatórios, incluindo a dose total de efedrina e fenilefrina por parto fetal e duração cumulativa de hipotensão materna, foram avaliados. A hipotensão materna foi refletida como uma diminuição da pressão arterial sistólica e da pressão arterial média para < 80% dos valores basais. A pressão arterial sistólica e a pressão arterial média foram incluídas independentemente em uma análise de regressão múltipla juntamente com todos os outros fatores explicativos para predizer o pH arterial umbilical. Resultados: Das 416 pacientes elegíveis, 381 foram inscritas. Ao incluir a pressão arterial sistólica ou pressão arterial média no modelo, os casos de emergência, a dose total de efedrina, os distúrbios hipertensivos da gravidez e os valores da pressão arterial sistólica ou da pressão arterial média foram considerados fatores preditivos significativos do pH arterial umbilical. Conclusão: Nossos resultados sugerem que um tempo integral elevado de hipotensão materna pode ter um impacto negativo no pH arterial umbilical. Portanto, para minimizar o risco de acidose fetal, a hipotensão materna deve ser prevenida considerando a seleção de vasopressores.
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References
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