Maternal and Neonatal Outcomes Associated with Different Anesthetic Techniques in Cesarean Delivery for Multiple Gestations: A Retrospective Study of 1,057 Patients
Patchareya Nivatpumin MD1, Tripop Lertbunnaphong MD2, Wanna Srirojanakul MD1, Sarasate Eiamtanasate MD, PhD1, Patcha Papaisarn MD1, Donpicha Woonprasert MD1
Affiliation : 1 Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 2 Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : The aim of the present study was to examine maternal and neonatal outcomes of cesarean delivery for multiple
gestations using different anesthetic techniques.
Materials and Methods : A retrospective chart review of 1,057 pregnant women with multiple gestations undergoing cesarean
delivery in 10-year period (August 2006 to December 2015) was performed. Patient demographic characteristics, choices of
anesthesia, intra-operative data and complications were collected. Maternal and neonatal complications were compared
between spinal anesthesia [SA] and general anesthesia [GA].
Results : A total of 984 (93.1%) patients received SA, whereas 73 (6.9%) received GA. The incidence of intra-operative
maternal hypotension and the proportion of patients requiring vasopressors were higher in the SA than GA group (p<0.001).
The intra-operative estimated blood loss volume was significantly higher in the GA than SA group (p = 0.007). Among
peripartum complications, the rate of postpartum hemorrhage (p = 0.003), the rate of blood transfusion (p = 0.001), and the
rate of hysterectomy (p<0.001) were significantly higher in the GA than SA group. However, there was no difference in the
incidence of uterine atony between the two groups. The neonatal Apgar scores at 1 and 5 minutes of first- and second-born
neonates were significantly higher in the SA than GA group (p<0.001). Although the neonatal death rate was not significantly
different between the groups, the rate of birth asphyxia was significantly higher in first- and second-born neonates from
women in the GA group (p<0.001).
Conclusion : General anesthesia in women with multiple gestations undergoing cesarean delivery is associated with more
complications than SA. Since this is a retrospective study, whether SA is a preferable anesthetic of choice in these patients
needs further study.
Keywords : Multiple gestations, Anesthetic technique, Cesarean delivery, Maternal outcome, Neonatal outcome, Hysterectomy
