Associated factors with umbilical arterial pH after cesarean delivery under spinal anesthesia: a retrospective cohort study

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...

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Main Authors: Miwa Kitaguchi, Mitsuru Ida, Yusuke Naito, Yuka Akasaki, Masahiko Kawaguchi
Format: Article
Language:English
Published: Elsevier 2022-07-01
Series:Brazilian Journal of Anesthesiology
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S0104001421001871
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author Miwa Kitaguchi
Mitsuru Ida
Yusuke Naito
Yuka Akasaki
Masahiko Kawaguchi
author_facet Miwa Kitaguchi
Mitsuru Ida
Yusuke Naito
Yuka Akasaki
Masahiko Kawaguchi
author_sort Miwa Kitaguchi
collection DOAJ
description 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.
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spelling doaj.art-2b49285bdb7641dc9ff59c5fb04524952022-12-22T02:05:38ZengElsevierBrazilian Journal of Anesthesiology0104-00142022-07-01724466471Associated factors with umbilical arterial pH after cesarean delivery under spinal anesthesia: a retrospective cohort studyMiwa Kitaguchi0Mitsuru Ida1Yusuke Naito2Yuka Akasaki3Masahiko Kawaguchi4Nara Medical University, Department of Anesthesiology, Kashihara, JapanCorresponding author.; Nara Medical University, Department of Anesthesiology, Kashihara, JapanNara Medical University, Department of Anesthesiology, Kashihara, JapanNara Medical University, Department of Anesthesiology, Kashihara, JapanNara Medical University, Department of Anesthesiology, Kashihara, JapanBackground: 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.http://www.sciencedirect.com/science/article/pii/S0104001421001871Anesthesia, spinalArterial pressure, meanCesarean sectionEphedrineFetal bloodHydrogen-ion concentration
spellingShingle Miwa Kitaguchi
Mitsuru Ida
Yusuke Naito
Yuka Akasaki
Masahiko Kawaguchi
Associated factors with umbilical arterial pH after cesarean delivery under spinal anesthesia: a retrospective cohort study
Brazilian Journal of Anesthesiology
Anesthesia, spinal
Arterial pressure, mean
Cesarean section
Ephedrine
Fetal blood
Hydrogen-ion concentration
title Associated factors with umbilical arterial pH after cesarean delivery under spinal anesthesia: a retrospective cohort study
title_full Associated factors with umbilical arterial pH after cesarean delivery under spinal anesthesia: a retrospective cohort study
title_fullStr Associated factors with umbilical arterial pH after cesarean delivery under spinal anesthesia: a retrospective cohort study
title_full_unstemmed Associated factors with umbilical arterial pH after cesarean delivery under spinal anesthesia: a retrospective cohort study
title_short Associated factors with umbilical arterial pH after cesarean delivery under spinal anesthesia: a retrospective cohort study
title_sort associated factors with umbilical arterial ph after cesarean delivery under spinal anesthesia a retrospective cohort study
topic Anesthesia, spinal
Arterial pressure, mean
Cesarean section
Ephedrine
Fetal blood
Hydrogen-ion concentration
url http://www.sciencedirect.com/science/article/pii/S0104001421001871
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