Impact of Maternal Spinal Anesthesia-Induced Hypotension at Scheduled Cesarean Delivery on Risk Development of Transient Tachypnea of Newborn and Fetal Acidosis: A Prospective Study

Background: Maternal hypotension resulting from spinal anesthesia and the interval between anesthetic administration and delivery are considered potential modifiable risk factors contributing to the development of transient tachypnea of the newborn (TTN) and fetal acidosis. To investigate the precise impact of maternal hypotension triggered by spinal anesthesia and the duration of anesthesia-to-delivery intervals on neonatal outcomes, primarily the incidence of TTN and fetal acid-base imbalance among women undergoing planned cesarean section (CS) deliveries. Methods: A pre-planned prospective cohort study was conducted over a one-year period at a tertiary care center, enrolling all women with non-anomalous singleton pregnancies between ۳۷ and ۴۱ weeks of gestation who delivered via elective CS under spinal anesthesia. The main outcome variables were the incidence of neonatal respiratory morbidity, specifically TTN, and fetal acidosis, evaluated in relation to maternal intraoperative hypotension and the interval from induction of anesthesia to delivery. Intraoperative maternal blood pressure profiles were systematically compared between neonates with TTN and those without. Results: A total of ۱۱۵ maternal-infant dyads were included in the final analytical cohort. Neonates who developed TTN were delivered by mothers who experienced more profound intraoperative hypotension, as evidenced by significantly lower minimum systolic blood pressure (SBP) (P = ۰.۰۰۶), diastolic blood pressure (DBP) (P = ۰.۰۱), and mean arterial pressure (MAP) (P = ۰.۰۰۳). Notably, maternal baseline MAP demonstrated a considerable inverse correlation with umbilical cord pH (r = -۰.۴۷۳, P < ۰.۰۰۱), whereas minimum MAP correlated positively (r = ۰.۳۲۴, P < ۰.۰۰۱). Multivariable analyses identified both the severity and duration of maternal hypotension as significant independent predictors of TTN and fetal acidosis. Conclusion: Implementing preventive measures against maternal spinal hypotension is a prudent strategy to minimize the likelihood of neonatal acidosis and reduce the risk of TTN in scheduled cesarean deliveries.

کلیدواژه ها:

Maternal hypotension ، Neonatal acidosis ، Scheduled cesarean delivery ، Spinal anesthesia ، Transient tachypnea of newborn