HIGHER RATE OF FETAL ACIDEMIA AFTER REGIONAL ANESTHESIA FOR ELECTIVE CESAREAN DELIVERY

Objective: To determine the prevalence of fetal acidemia associated wi th regional anesthesia for elective cesarean delivery in healthy patur ients with uncomplicated singleton term pregnancies. Methods: This was an epidemiologic study using the data base of the Swiss obstetric stu dy group (Arbeitsgemeinschaft Schweizerischer Frauenkliniken). After t he exclusion of cases with extraneous factors that may have affected t he health of the neonate, we analyzed the umbilical artery pH, Apgar s core, and other neonatal outcome measures after cesarean delivery with reference to the anesthetic technique. Results: From 1985 to 1994, 32 7,763 deliveries, including 40,858 (12.47%) by cesarean, were register ed in the data base. Of these, 5806 patients fulfilled the study crite ria. The study population included 1002 spinal, 2155 epidural, and 264 9 cases of general anesthesia. The frequency of fetal acidemia (pH les s than 7.10) was significantly increased in the spinal-anesthesia grou p (odds ratio [OR] 4.67; 95% confidence interval [CI] 2.73, 8.01) and in the epidural group (OR 2.39; 95% CI 1.42, 4.04) compared with the g eneral-anesthesia group. Conclusion: The rate of fetal acidemia is sig nificantly increased after regional anesthesia. This risk must be judg ed in light of the risks inherent with general anesthesia. (C) 1997 by The American College of Obstetricians and Gynecologists.