Fetomaternal Outcome in Severe Preeclamptic Women Undergoing Emergency Cesarean Section with Spinal or General Anesthesia

Abstract

Background: Preeclampsia (PE) is a hypertensive disease specific to pregnancy and it complicates 5–10 % of all pregnancies and it is a major cause of maternal, fetal, and neonatal morbidity and mortality worldwide. Preeclampsia is defined as new-onset hypertension (systolic blood pressure 140 mm Hg or diastolic blood pressure 90 mm Hg) and new-onset proteinuria after 20 weeks of gestation in previously normotensive patients. Objective: The aim of this work is to show the fetomaternal outcome of severe preeclampsia in women undergoing emergency cesarean section with either spinal or general anesthesia. Which better? Patients and Methods: This study was conducted at El Sayed Galal and El Hussein University Hospitals. 180 pregnant women with severe preeclampsia admitted to the operating room for emergency cesarean section were included and divided into 2 groups: Group I: 150 patients underwent cesarean section under spinal anesthesia. Group II: 30 patients underwent cesarean section under general anesthesia. This study was prospective observational study. The patients fulfilled our inclusion criteria and signed a well informed consent to declare their agreement to be in this study as agreed upon by the ethical committee. Results: The mean values of DBP were significantly higher in group II than in group I (p <0.05). The incidence of maternal complications was significantly higher in group II more than group I, especially in vomiting, high blood pressure and convulsion (p <0.05). There was a significant increase in neonatal weight in group I more than group II (p <0.05). Regarding preterm, there was a significant increase in preterm cases in group II (60%) more than group I (38%) (p <0.05). Regarding APGAR score at 1 and 5 min, it was found that there was a significant increase in APGAR score in group I more than group II at both 1 minute and 5 minutes (p <0.05). The mean values of neonatal heart rate were significantly higher in group II than in group I (p <0.05). The mean values of neonatal respiratory rate were significantly higher in group I than in group II (p <0.05). Regarding breast feeding after cesarean section (hrs.), there was a significant increase in the duration after cesarean section till the breast feeding in group II more than group I (p < 0.05). Regarding neonatal mortality, there was a significant increase in mortality in group II (16.7%) more than group I (2.7%), (p <0.05). Conclusion: This means that spinal anesthesia is a safer alternative to general anesthesia in severe preeclampsia with less postoperative morbidity and mortality regarding both mothers and babies. These findings agreed with many previous studies worldwide.