Best neonatal outcome following emergency cesarean delivery in nonreassuring fetal heart rate: General or a low-dose spinal anesthesia

Abstract

Aims: Spinal hypotension using conventional local anesthetic doses for elective cesarean delivery (CD) has been associated with fetal acidosis. The optimum anesthetic technique for laboring women with nonreassuring fetal heart trace (FHR) and its effects on neonatal outcome has not been well studied. Materials and Methods: Thirty laboring parturients with a nonreassuring FHR undergoing emergency CD (category 2) were included in this study. The parturients were randomized to receive a low-dose spinal anesthesia (LDSA group) 8 mg hyperbaric 0.5% bupivacaine with 20 μg fentanyl, or standard general anesthesia (GA group). Systolic blood pressure was maintained at >100 mmHg till delivery of the fetus using phenylepherine boluses. The primary outcome variable was cord blood gas base excess >8 meq/L.Statistical Analysis: Assuming an SD of 7.5 and difference of 5 as clinically significant difference in base deficit, we required 15 patients in each group with α of 0.05 and power of 90%. Student's t test, two-way repeated measures analysis of variance (ANOVA) and Chi square test were used to analyze the data. Results: The incidence of fetal acidosis was higher in the GA group. Lower APGAR scores at 1 and 5 min and a greater need for immediate resuscitation was observed in fetuses exposed to GA. All patients in the LDSA group achieved adequate surgical block as well as stable hemodynamics. No adverse event was observed with either of the techniques.Conclusion: A LDSA is associated with better neonatal outcome in women with nonreassuring FHR as compared with GA.