Anesthesia Choices for C-Section Lead to Similar Outcomes for Mom, Baby

A new systematic review compared regional and general anesthesia in women undergoing Caesarean section and their respective effects on mom and baby.

The review found little significant difference with respect to major clinical outcomes - although some women had lower blood counts and shivering after C-section with general anesthesia and some experienced more nausea and vomiting with regional anesthesia.

This was the first such review to consider both neonatal and maternal outcomes related to regional or general anesthesia used during C-section. Previous reviews have considered only the baby's well-being - not also the mom's.

"We found no evidence to suggest that one form of anesthesia was superior to the other for Caesarean section, when comparing general with regional anesthesia, in terms of major outcomes such as the well being of the baby," said lead author Dr. Bosede B. Afolabi, a senior lecturer and consultant at the Department of Obstetrics and Gynecology of the College of Medicine/Lagos University Teaching Hospital in Nigeria.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

For the review, the authors analyzed sixteen randomized controlled trials involving 1586 women who had given birth by C-section. The women had received either regional or general anesthesia.

Multiple newborn outcome measures were considered in the review, including neonatal death, Apgar scores, umbilical pH, neonatal adaptive capacity scores and need for oxygen by mask or intubation.

Outcome measures involving the mom included maternal death, differences in hematocrit or hemoglobin levels (both measures of anemia) before and after C-section, incidence of postoperative wound infection, intraoperative pain, and satisfaction with the anesthetic technique used.

According to Afolabi, maternal or neonatal death was not reported in any trial in the review, underscoring the relative safety of the Caesarean procedure.

"There appeared to be reduced blood loss with the use of regional anesthesia, however, and this applied to both spinal and epidural forms," she said. "Despite the fact that the review did not find a difference in the need for blood transfusions, this reduced blood loss may be relevant, as wound healing is slower in people with anemia."

"This review confirms what we have known for the past 20 years - for delivery, regional anesthesia is safer than general anesthesia," said Charles J. Lockwood, M.D., professor and chair of the Department of Obstetrics, Gynecology and Reproductive Sciences at Yale University School of Medicine.