Effect of anesthesia administration method on apgar scores of infants born to women undergoing elective cesarean section

Chipo Gwanzura; Samuel Gavi; Marcia Mangiza; Faith Vhenekai Moyo; Matthew C Lohman; Taazadza Nhemachena; Tsungai Chipato

doi:10.1186/s12871-023-02098-w

Effect of anesthesia administration method on apgar scores of infants born to women undergoing elective cesarean section

BMC Anesthesiol. 2023 Apr 27;23(1):142. doi: 10.1186/s12871-023-02098-w.

Authors

Chipo Gwanzura¹, Samuel Gavi², Marcia Mangiza³, Faith Vhenekai Moyo⁴, Matthew C Lohman⁵, Taazadza Nhemachena¹, Tsungai Chipato^{1

6}

Affiliations

¹ Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe.
² Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA. sgavi@email.sc.edu.
³ Department of Pediatrics, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe.
⁴ Department of Anesthesia and Critical Care Medicine, Sally Mugabe Central Hospital, PO Box ST14 Southerton, Harare, Zimbabwe.
⁵ Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
⁶ Clinical Trials Research Centre, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.

Abstract

Background: Neonatal health at delivery as measured by apgar scores is an important outcome. This study was done to assess the impact of anesthesia on Apgar 1-minute and 5-minute scores of infants delivered through elective cesarean section in Zimbabwe.

Methods: We carried out a secondary analysis of data from the Efficacy of Tranexamic Acid in Preventing Postpartum Hemorrhage (ETAPPH) clinical trial in Zimbabwe. Outcomes measured were infant Apgar scores at 1 and 5 min, exposure was the administration of either a general (intravenous propofol/ketamine/sodium thiopental) or spinal (hyperbaric bupivacaine 0.5%) anesthesia for anesthesia during the elective cesarean section procedure. Marginal Structural Logistic Modelling (MSM) using an unstabilized Inverse Probability Treatment Weight (IPTW) estimator was used to assess the relationship between anesthetic administration method and infant Apgar scores.

Results: Four hundred and twenty-one (421) women who had an elective caesarean section in the ETAPPH study had their infants assessed for Apgar scores. Comparing general anesthesia to spinal anesthesia, spinal anesthesia was related to good Apgar scores at 1-minute (adjusted odds ratio [aOR] = 4.0, 95% Confidence Interval = 1.5-10.7, sensitivity analysis E-value = 3.41). Spinal anesthetic administration was also related to good Apgar scores at 5 min (adjusted odds ratio [aOR] = 6.2, 95% Confidence Interval = 1.6-23.1, sensitivity analysis E-value = 4.42).

Conclusions: When providing anesthesia for patients undergoing elective cesarean section, care should be taken on the method of administration of anesthetic agents. General anesthesia tends to depress Apgar scores at 1 min, although most neonates recover and have better scores at 5 min. Spinal anesthesia should be the first choice whenever possible.

Trial registration: The clinical trial from which data of this study was abstracted was registered under clinical trials registration number NCT04733157.

Keywords: Apgar scores; Elective cesarean section; General anesthesia; Marginal structural logistic modelling; Spinal anesthesia.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Anesthesia, Obstetrical*
Anesthesia, Spinal*
Apgar Score
Cesarean Section / methods
Female
Humans
Infant
Infant, Newborn
Parturition
Pregnancy
Propofol*

Substances

Propofol

Associated data

ClinicalTrials.gov/NCT04733157