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Am J Perinatol 2017; 34(07): 716-721
DOI: 10.1055/s-0036-1597847
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Obesity and Neonatal Cord Blood Gas Results at Cesarean: Effect of Intraoperative Blood Pressure

Mark F. Powell
1   Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
,
Charity J. Morgan
1   Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
,
Jessica A. Cantu
3   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
4   Texas Perinatal Group, Austin, Texas
,
Yasser Sakawi
1   Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
,
Joseph R. Biggio
3   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Alan T. N. Tita
3   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Jeff M. Szychowski
2   Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
3   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Rodney K. Edwards
3   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
5   Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
› Author Affiliations
Further Information

Publication History

14 September 2016

30 November 2016

Publication Date:
28 December 2016 (online)

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Abstract

Objective Our aims were to evaluate whether there is an inverse association between body mass index (BMI) and umbilical artery pH and to investigate the contribution of intraoperative hypotension on the umbilical artery pH.

Study Design We conducted a retrospective cohort study of all women with a nonanomalous singleton at 37 to 41 weeks who underwent a scheduled cesarean delivery under spinal anesthesia at our facility from January 2006 to March 2012. The primary outcome was the proportion of patients in each BMI category with arterial cord pH < 7.10. Intraoperative blood pressure data were compared across BMI categories.

Results In total, 717 mother–infant pairs met enrollment criteria. Mean arterial pH was significantly lower in women with elevated BMI (p = 0.014), notably with BMI ≥ 40 kg/m2. Baseline blood pressure increased linearly with increasing BMI (p < 0.001), however, so did the maximum drop in all blood pressure parameters (p < 0.001). After adjusting for potential confounders, including blood pressure, there was no longer an association between cord pH and BMI (p = 0.72).

Conclusion For women undergoing a scheduled cesarean delivery under spinal anesthesia, umbilical artery pH is lower in women with BMI ≥40 kg/m2. Relative hypotension after spinal anesthesia is more pronounced with increasing BMI and may explain this effect.

Keywords

cesarean delivery - maternal obesity - neonatal acidemia - spinal-induced hypotension

Supplementary Material

 

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