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Am J Perinatol 2023; 40(03): 227-234
DOI: 10.1055/s-0042-1757861
SMFM Fellowship Series Article

General versus Regional Anesthesia and Neonatal Data: A Propensity-Score-Matched Study

Liviu Cojocaru 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, Maryland
,
Cristiana Salvatori
2   Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, Maryland
,
Amir Sharon
2   Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, Maryland
,
Hyunuk Seung
3   Department of Pharmacy Practice and Sciences, University of Maryland School of Pharmacy, Baltimore, Maryland
,
Katherine Nyman
4   Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
,
Bhavani S. Kodali
5   Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
,
Ozhan M. Turan
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, Maryland
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Abstract

Objective This study aimed to evaluate whether there is a difference in neonatal outcomes with general anesthesia (GA) versus regional anesthesia (RA) when induction of anesthesia to delivery time (IADT) is prolonged (≥10 minutes).

Study Design This is a retrospective case–control study that included cases from July 2014 until August 2020. We reviewed all singleton pregnancies delivered between 24 and 42 weeks of gestation with IADT ≥ 10 minutes. Urgent deliveries, those who received RA for labor pain management or started cesarean delivery under RA and converted to GA, as well as cases with fetal anomalies, were excluded. The propensity score (PS) matching method was performed using age, ethnicity/race, body mass index, gestational age at delivery, preexisting maternal comorbidities, and pregnancy complications. Analyses were performed with SAS software version 9.4.

Results During the study period, we identified 258 cases meeting inclusion criteria. After the PS matching was applied, the study sample was reduced to 60 cases in each group. The median IADT and uterine incision to delivery time were similar between groups (41.5 [30.5, 52] vs. 46 minutes [38, 53.5], p = 0.2 and 1.5 [1, 3] vs. 2 minutes [1, 3], respectively). There was no significant difference between groups with respect to arterial or venous cord pH (7.24 [7.21, 7.26] vs. 7.23 [7.2, 7.27], p = 0.7 and 7.29 [7.26, 7.33] vs. 7.3 [7.26, 7.33], p = 0.4, respectively). Nor were there any associations between maternal characteristics and Apgar's score at 5 minutes, except for Apgar's score at 1 minute (p < 0.001). No significant difference was identified in the rate of admission to the neonatal intensive care unit (NICU; 11 [52.4%] vs. 10 [47.6%], p = 0.8) or NICU length of stay between GA and RA (4 [3, 14] vs. 4.5 [3, 11], p = 0.9).

Conclusion Our data indicate that even with prolonged IADT, favorable neonatal outcomes are seen with both GA and RA, in contrast with previous studies performed decades ago.

Key Points

  • Improving cesarean delivery safety, including the safety of anesthesia, is of paramount importance.

  • Reappraisal of historical outcomes is warranted as advances in the medical field unfold.

  • Favorable neonatal outcomes are seen with both general and regional anesthesia.

Keywords

general anesthesia - regional anesthesia - neonatal outcomes - prolonged IADT - propensity score (PS) matching

Authors' Contributions

L.C. and O.M.T. drafted the manuscript. K.N. described the neonatal intensive care unit protocols and elaborated the corresponding part of the study methodology. B.S.K. generated the study idea, described the obstetric anesthesia protocol, and elaborated the corresponding part of the study methodology. H.S. performed the statistical analysis and ensured its correct interpretation. All authors contributed to the writing, editing, and approving the final version.


Supplementary Material



Publication History

Received: 21 September 2021

Accepted: 14 March 2022

Article published online:
01 October 2022

© 2022. Thieme. All rights reserved.

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