الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 113 |  |  |
| | | from | 113 | | |
Abstract
Spinal anesthesia is the most commonly used technique for planned caesarean delivery owing to the rapid onset of effective anesthesia and avoidance of fetal exposure to anesthetic drugs and of maternal risks from general anesthesia. The major disadvantage of spinal anesthesia is maternal hypotension; Spinal hypotension occurs in up to 74% of planned caesarean deliveries when prophylactic vasopressor infusions are not used and is associated with fetal acidosis (Kinsella et al., 2018).
Both maternal hypotension and prolonged intraoperative time intervals during this predelivery window contribute to adverse neonatal outcome but their relative clinical importance and critical thresholds warrant further investigation (Powell et al., 2017).
This Prospective cohort study aimed to evaluate the relation between predelivery time intervals started from end of induction of spinal anesthesia till delivery and neonatal umbilical arterial pH at scheduled term caesarean delivery as a method to evaluate neonatal outcome.
After obtaining approval from the Ain Shams maternity hospital ethical committee and written informed consents from all patients undergoing any elective caesarian section and meeting our inclusion criteria, study of the effect of time from spinal anesthesia to delivery in planned caesarean deliveries on neonatal outcome, primarily neonatal acidosis will be carried out for 220 adult female patients.
Inclusion criteria:
• Elective caesarean deliveries under spinal anesthesia
• Singleton pregnancy.
• Gestational age: 38 to 39 weeks.
• Each patient had reassuring non-stress test prior to delivery.
Exclusion criteria:
• Planned additional surgery (caesarean hysterectomy, adnexal surgery).
• In labor.
• Fetal anomalies.
• Anesthesia methods other than spinal.
• Umbilical cord gas analyses were unavailable or if time documentation was incomplete.
• Maternal and obstetric complications as polyhydramnios, oligohydramnios antepartum hemorrhage.
Our study showed that the induction of spinal anesthesia to delivery time (min.) was more than 40 min. in 5 pt. and in the same time the induction of spinal anesthesia to delivery time (min.) was 30-39 in 33 pt. while the duration was 20-29 in 164 pt and it was less than 20 min. in 18 pt. and this was associated with pH less than 0.7 in 4 babies and pH ranged between 7.01-7.10 in 6 babies and pH range of 7.11-7.2 in 30 babies while the range of 7.21-7.3 was in 57 babies and the majority of babies had pH more than 7.3.Statisticaly the relation between induction of spinal anesthesia to delivery time and fetal Ph. was highly significant with p value less than 0.001.
Our study also showed that a receiver-operating characteristic curve of the induction of spinal anesthesia to delivery time demonstrated that a time greater than 27 min. was associated with pH. less than 7.2(accuracy, sensitivity and specificity was 91.2%, 91.2% and 76.3% respectively).
In our study the range of body mass index (BMI) was 24-39 with mean±SD of 33.45±2.75 and there was statistically highly significant relation between (BMI) and fetal umbilical cord pH.
A receiver-operating characteristic curve of the body mass index (BMI) demonstrated that a BMI greater than 35 was associated with pH less than 7.2(accuracy, sensitivity and specificity was 77.1%, 67.7% and 83.3% respectively).
Our study also found statistically highly significant relation between the longest duration of hypotensive episode and fetal outcome in the form of umbilical arterial cord pH.
The range of the longest duration of hypotensive episode was 0-9 min. with Mean ±SD of 3.35±2.19. A receiver-operating characteristic curve of the longest duration of hypotensive episode demonstrated that duration of hypotension episode more than 5 min. was associated with pH less than 7.2 (accuracy, sensitivity and specificity was 67.8%, 67.7% and 60.8% respectively).
Finally, we concluded that the time from induction of spinal anesthesia to delivery time was a strong dependent risk factor of neonatal acidosis also we found that not only the maternal hypotension but also the duration of hypotension and BMI could participate in the neonatal outcome.