272 - Hypotension after Spinal Anesthesia: Maternal Predictors of NICU admission in Elective Term C-sections

Poster Number: 272
Publication Number: 272.2086

Background: Elective c-sections occur in < 39 week pregnancies due to maternal risk factors. We previously reported maternal hypotension after spinal anesthesia (MHASP) was associated with increased risk of NICU admission in term elective c-s deliveries (TECD). Our previous cohort was relatively small, and we wanted to confirm our previous findings and further investigate what maternal clinical risk factors might be used to predict NICU admission and complications.

Objective: What clinical and MHASP parameters predict need for resuscitation and NICU admission?

Design/Methods: Elective c-sections at 37-41 weeks born at one institution were reviewed. Maternal variables: diabetes (DM), Hypertension (HTN), delivery BMI, age, race/ethnicity, parity, pregnancy complications, systolic, diastolic, mean blood pressure (BP), baseline (BP)and baseline & lowest BP prior and after spinal anesthesia. Neonatal variables: Apgar scores, resuscitation, admission to NICU (or limited NICU observation), birth weight, length, head circumference, and percentiles. Multivariate analysis with logistic regression of maternal risk factors vs neonatal outcomes was performed. Binary outcome measures were NICU admission, 1 Minute APGAR < 7, 5 Minute APGAR < 7. Delivery room respiratory support, (DRRS) and delivery room oxygen (DROxy) & Resp Distress. BP drops were defined as percent change of SBP or DBP, or MAP from baseline to trough after spinal c-section prior to delivery. Logistic regression models were used to predict odds of outcome measures using blood drops as predictors, after adjusting for covariates including maternal demographics and risk factors such as BMI, hypertension (HTN) and diabetes (DM).

Results: A total of 401 singleton cases were studied. Odds ratios of NICU Admission, DR Resp Support and DR Oxy < 0.21 Fi02 were found positively associated with blood pressure drop using either SBP, DBP, or MAP. SBP drop or MAP drop were associated with increased risk of 1 Minute APGAR < 7 and need for oxygen and respiratory support. (Table 1) Maternal DM and Gestation at 37 weeks was also found to be a significant risk for NICU admission in TECD.

Conclusion(s): Risk of NICU admission after TECDs was significantly associated with maternal drop in systolic and diastolic BP prior to delivery. Maternal hypotension prior to delivery negatively impacted neonatal wellbeing. Decisions regarding attendance at elective term c-sections may use these risk factors to assign appropriate personnel. In addition, Anesthesiologists may find techniques to limit BP drops in c-section deliveries. .