Poster Session 4
Patricia Rojas Mendez, MD (she/her/hers)
Maternal-Fetal Medicine Fellow
SUNY Upstate Medical University
Syracuse, New York, United States
Rachael Sampson, MD
Maternal-Fetal Medicine Fellow
SUNY Upstate Medical University
Syracuse, New York, United States
Jordan A. Gillenwater, DO
Maternal-Fetal Medicine Fellow
SUNY Upstate Medical University
Syracuse, New York, United States
Marcia Des Jardin, MD (she/her/hers)
MFM-Genetics Fellow
University of Alabama at Birmingham
Birmingham, Alabama, United States
Nicholas Baranco, MD (he/him/his)
Assistant Professor, Division of Maternal-Fetal Medicine
SUNY Upstate Medical University
Syracuse, New York, United States
Robert Silverman, MD
Professor, Obstetrics & Gynecology
SUNY Upstate Medical University
Syracuse, New York, United States
Hypertensive disorders of pregnancy (HDP) are a leading cause of adverse obstetrical and neonatal outcomes. No optimal anesthesia strategy is established for pregnancies affected by HDP. The study objective is to compute the association between type of anesthesia and maternal and short-term neonatal adverse outcomes among patients with HDP undergoing cesarean delivery (CD).
Secondary analysis was performed on a cohort of 736 patients who underwent CD at our institution from 2022-2023. HDP was stratified into five groups: chronic hypertension (HTN), gestational HTN, preeclampsia without severe features (SF), preeclampsia with SF (including HELLP and eclampsia), and superimposed preeclampsia. The primary outcome was a composite of maternal morbidity (CMM) (postoperative (PO) fever, PO antibiotics, blood transfusion, intensive care unit (ICU) admission, reoperation, readmission and death) in patients undergoing general vs. neuraxial anesthesia for CD. Secondary outcomes were Apgars < 7 and neonatal ICU admission. Multivariate logistic regression was performed. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) for primary and secondary outcomes were calculated after controlling for potential confounders.
In the cohort, 546 patients (74%) had HDP and were included in the analyses. Of these, 14% received general anesthesia and 86% received neuraxial anesthesia. Demographic characteristics and other preoperative risk factors were similar in both groups (Table 1). After adjusted analysis, general anesthesia was associated with higher rates of CMM when compared to neuraxial anesthesia among all groups (aOR 3.96, 95% CI 1.54, 10.22). The association was maintained after controlling for urgency, gestational age and delivery indication. We found no association between the type of anesthesia and 5-minute Apgar < 7 or neonatal ICU admission (Table 2).
Among patients with HDP undergoing CD, general anesthesia is associated with higher rates of adverse maternal outcomes even after controlling for urgency and delivery indication.
