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Anaesthesia for caesarean section and neonatal acid-base status: a meta-analysis
Open accessAbstract
Summary: Spinal anaesthesia is generally preferred for Caesarean section. Its superiority for the baby is often assumed. Umbilical artery acid‐base status provides a valid index of fetal welfare. Twenty‐seven studies reporting neonatal acid‐base data with different types of anaesthesia were used to compare umbilical artery or vein pH and base deficit, using random‐effect meta‐analysis. Cord pH was significantly lower with spinal than with both general (difference: −0.015; 95% CI −0.029 to −0.001; 13 studies, 1272 subjects) and epidural anaesthesia (difference −0.013; 95% CI −0.024 to −0.002; 11 studies, 828 subjects). Larger doses of ephedrine contributed to the latter effect (p = 0.023). Sixteen studies reported a base deficit, which was significantly higher for spinal than for general (difference 1.109; 95% CI 0.434–1.784 mEq.l −1 ; seven studies, 695 subject) and epidural anaesthesia (difference 0.910; 95% CI 0.222–1.598 mEq.l −1 ; seven studies, 497 subjects). Spinal anaesthesia cannot be considered safer than epidural or general anaesthesia for the fetus.
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In a meta-analysis comprising 27 studies, Reynolds and Seed found that spinal anesthesia was associated with a higher degree of fetal metabolic acidemia than was either general or epidural anesthesia.
“However, in a meta-analysis comprising 27 studies reporting neonatal acid-base data with different types of anesthesia, Reynolds and Seed 46 found that spinal anesthesia was associated with a higher degree of fetal metabolic acidemia than was either general or epidural anesthesia (EDA).”
From Umbilical cord pH, blood gases, and lactate at birth: normal values, interpretation, and clinical utility. (2023) · cites this paper as [46]
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References 90 · Cited by 266
Research works printed but not linked: 2
- Gokpinar B, 1995, The effect of general and spinal anaesthesia on acid‐base status of newborn and Apgar scoring in elective Caesarean section, Turk Anesteziyoloji Ve Reanimasyon, 23, 297
- Swami A, 2004, Comparison of measured and estimated angles of operating table tilt among varying grades of anaesthetists [Abstract], International Journal of Obstetric Anesthesia, 13, S10
Metadata
- Authors
- Reynolds, F., & Seed, P. T.
- Affiliations
- St Thomas' Hospital (GB)
- King's College London (GB)
- Corresponding author
- Reynolds, F.
- ORCID
- Seed, P. T.
- Venue
- Anaesthesia
- Publisher
- Wiley
- Published
- 2005-06-16
- Volume
- 60
- Issue
- 7
- Pages
- 636-653
- ISSN
- 0003-2409 (ISSN-L)
- 1365-2044
- OpenAlex
- W2051287378
- Cited by
- 266
- References
- 90
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 4 · 2023: 11 · 2022: 15 · 2021: 12 · 2020: 16 · 2019: 17 · 2018: 16 · 2017: 12 · 2016: 14 · 2015: 7 · 2014: 15 · 2013: 10 · 2012: 25
- FWCI
- 1.80
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Anaesthesia (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Wellcome Trust
- Tommy's
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Keywords
- cesarean section, spinal anesthesia, epidural anesthesia, general anesthesia, umbilical cord pH, base deficit, neonatal acid-base status, fetal well-being, obstetric anesthesia
- MeSH terms
- Acid-Base Equilibrium, Acidosis, Anesthesia, Epidural, Anesthesia, General, Anesthesia, Obstetrical, Anesthesia, Spinal, Cesarean Section, Female, Fetal Diseases, Humans, Maternal-Fetal Exchange, Pregnancy
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