Nigerian Journal of Clinical Practice

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Perinatal outcome of preterm cesarean section in a resource-limited centre: A comparison between general anaesthesia and subarachnoid block

MI Nwafor, UU Aniebue, TO Nwankwo, TC Onyeka, VU Okafor


Background: The relationship between perinatal outcome and anesthetic technique for preterm cesarean sections has not been explored in South Eastern, Nigeria.
Objective: The objective of the following study is to evaluate perinatal outcome in preterm cesarean sections conducted under general anesthesia (GA) and subarachnoid block (SAB) with the aim to ascertain any difference in outcome between the two methods.
Materials and Methods: Aretrospective observational study of consecutive preterm cesarean deliveries at the University of Nigeria Teaching Hospital from May 1999 to April 2008. Data entry and statistical analysis utilized the SPSS statistical package for the social sciences, 2008 version 15.0 for windows (SPSS Inc, Chicago IL, USA). Chi.square test was done to determine statistical significance and P . 0.05 were considered to be significant at 95% confidence interval. The delivery characteristics were compared by logistic regression analysis to ascertain any associated confounding effect on perinatal outcome in those exposed to either anesthetic technique.
Results: There were 7568 deliveries and 1961 cesarean sections giving a cesarean section rate of 25.9%. A total of 236 cesarean sections were for preterm deliveries giving a preterm cesarean section rate of 3.1%. Of these, 151 women delivered under GA while SAB was used in 85 cases. The mean gestational ages for preterm cesarean sections were 33.2 ± 2.6 weeks and 33.8 ± 2.2 weeks for those who had GA and SAB respectively. The mean Apgar scores were 6.4 ± 3.1 and 7.6 ± 3.1 at 5 min for GA and SAB respectively. There were 24 stillbirths (15.9%) in cesarean deliveries done under GA and 7 stillbirths (8.2%) in women who had SAB (P = 0.09). Twenty-two (14.6%) babies delivered through GA and 14 (16.4%) delivered under SAB, died within 1 week of delivery (P = 0.7). There were more babies with low Apgar scores in parturient delivered under GA (P = 0.0004). More preterm babies delivered under SAB were discharged from the New Born Special Care Unit within 10 days of delivery (P = 0.006). Hypertensive disorders, though not statistically significant was the most common  indication for preterm cesarean delivery among those with GA and SAB. No maternal death occurred during the study period.
Conclusion: The study infers a strong association between anesthetic technique and immediate Apgar scores and outcome of resuscitation following preterm cesarean section. This however, failed to translate into higher differences in perinatal mortality.

Key words: General anesthesia, perinatal.outcome, preterm cesarean section, subarachnoid block
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