Abstract
The purpose of this international survey was to describe the impact of current practices and techniques of caesarean section on the neonatal Apgar score in the Czech Republic (CZE) and Slovakia (SVK). All Czech and Slovak departments that provide obstetric anaesthesia were invited to participate in a one-month (November 2015) prospective study that monitored in details all peripartum anaesthetic practices, delivered by anaesthesiologists. Participating centers recorded all data on-line in the CLADE-IS database (Masaryk University, CZE). We collected data of 10119 women who delivered 10226 newborns. A caesarean section was recorded in 25.1% of deliveries (CZE 23.2%; SVK 30%). General anaesthesia was used for caesarean section in 37.5% of the cases (CZE 40%, SVK 33%). There was no statistically significant difference in the Apgar score lower than 7 in the 1, 5 or 10 min in groups of general and regional anaesthesia for caesarean section, when only elective sections of in-term babies with birth weight over 2500 g were analyzed. We found no statistically significant differences in the Apgar score in newborns of women intubated for caesarean section in rocuronium (n=21; 2.2%) and suxamethonium (n=889; 93%). We found no difference in neonatal outcomes in groups of general and regional anaesthesia for caesarean section when only out-of-risk newborns were analyzed. The risk factors were identified as follows: an acute caesarean section, preterm babies, birth weight less than 2 500 g, born in perinatological center and multiple pregnancy - second baby. ClinicalTrials.gov (ID: NCT02380586) https://clinicaltrials.gov/ct2/show/NCT02380586.
Highlights
Obstetric general anaesthesia is a challenging area to study and its effects on maternal and neonatal outcomes must be considered
Rocuronium has been associated with a lower Apgar score at one minute compared to suxamethonium, but no differences have been found between the two neuromuscular blockers in the Apgar scores at five and ten minutes or the umbilical arterial blood gases[6]
In 2011, we performed a national study Obstetric Anaesthesia and Analgesia Month Attributes in the Czech Republic (OBAAMA-CZ), which demonstrated that use of general anaesthesia (GA) was common to facilitate caesarean section (CS)
Summary
Obstetric general anaesthesia is a challenging area to study and its effects on maternal and neonatal outcomes must be considered. The classical technique of rapid sequence induction with predetermined doses of thiopentone and suxamethonium, cricoid pressure and avoidance of ventilation until Âtracheal intubation continues to evolve with the use of propofol and rocuronium being more commonplace[2,3,4,5]. In 2011, we performed a national study Obstetric Anaesthesia and Analgesia Month Attributes in the Czech Republic (OBAAMA-CZ), which demonstrated that use of general anaesthesia (GA) was common to facilitate caesarean section (CS). Subsequent to this, the Obstetric Anaesthesia and Analgesia Month Attributes International (OBAAMA-INT) survey was undertaken in the Czech Republic and Slovakia[7,8]. Its primary aim was to assess the practices and techniques in an obstetric anaesthesia care, in particular for labour analgesia and CS, in 2015 (ref.[9]). Due to an intensive educational activity in years 2011-2015 there was a significant increase in the rate of regional anaesthesia for CS (63% vs. 53%) (ref.[7,10])
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