The anesthetic management of triplet cesarean delivery: A retrospective case series of maternal outcomes

Spinal anesthesia for the cesarean delivery of triplets is associated with an increased incidence of maternal hypotension and placental hypoperfusion. We performed a retrospective case series analysis between January 1992 and June 2000 to evaluate the effects of regional anesthetic techniques for ce sarean delivery in triplet pregnancies on maternal and neonatal outcome. Sp inal and epidural anesthesia were compared with respect to intraoperative h emodynamics and neonatal outcomes. Ninety-six triplet pregnancies were deli vered by cesarean section, of which 91 received regional anesthesia. A stat istically significant decrease in systolic blood pressure was demonstrated immediately after the induction of spinal as compared with epidural anesthe sia. The total volume of IV crystalloid used was significantly larger in th e Spinal Anesthesia group. The number of patients receiving more than 15 mg of ephedrine and the cumulative dose of ephedrine was significantly larger in the Spinal group compared with the Epidural group. There were no differ ences in the rate of perioperative complications between the Spinal and Epi dural Anesthesia groups. Neonatal Apgar scores were similar in both groups. The data suggest that both epidural and spinal anesthesia for triplet cesa rean delivery are safe techniques, but the latter is associated with a larg er initial decrease in systolic blood pressure. This decreasing of systolic blood pressure, however, remained within the physiological range and did n ot seem to be clinically significant. The need for more crystalloid fluids and ephedrine should be anticipated when spinal anesthesia is used for thes e cases.