Cesarean delivery is one of the most common surgical procedures worldwide, and the choice of anaesthesia is a critical determinant of maternal and fetal outcomes. General anaesthesia (GA) and regional anaesthesia (RA), including spinal and epidural techniques, are the two primary options for cesarean deliveries. While GA is often used in emergencies, RA is preferred for elective procedures due to its perceived safety profile. However, the comparative impact of these anaesthesia techniques on maternal hemodynamic stability, postoperative recovery, and fetal well-being remains a topic of ongoing research.

This study aims to evaluate the impact of GA and RA on maternal and fetal outcomes in cesarean deliveries, providing evidence-based insights to guide clinical decision-making.

Study Design: 

A prospective observational study was conducted over 12 months at a tertiary care hospital.

Participants: 

400 women undergoing cesarean delivery were enrolled and divided into two groups:

• Group GA: 200 women receiving general anaesthesia.
• Group RA: 200 women receiving regional anaesthesia (spinal or epidural).
  Exclusion criteria included multiple pregnancies, pre-existing maternal comorbidities (e.g., severe cardiac disease), and fetal anomalies.

Data Collection:

• Maternal Outcomes:
• Hemodynamic stability (intraoperative blood pressure and heart rate).
• Postoperative pain scores (using the Visual Analog Scale, VAS).
• Complications (e.g., nausea, vomiting, respiratory depression).
• Fetal Outcomes:
• Apgar scores at 1 and 5 minutes.
• Umbilical cord pH.
• NICU admissions.

Statistical Analysis: Data were analyzed using SPSS v26. Continuous variables were compared using Student’s t-test, and categorical variables using chi-square tests. A p-value <0.05 was considered statistically significant.

This study evaluated the impact of general anaesthesia (GA) and regional anaesthesia (RA) on maternal and fetal outcomes in 400 women undergoing cesarean delivery. The key findings are summarized below:

Maternal Outcomes

1. Hemodynamic Stability:
• RA was associated with significantly better hemodynamic stability compared to GA (12% vs. 35%, p<0.01).
• Fewer episodes of hypotension and tachycardia were observed in the RA group.
2. Postoperative Pain:
• Postoperative pain scores (measured using the Visual Analog Scale, VAS) were significantly lower in the RA group (3.8 ± 1.2 vs. 6.2 ± 1.5, p<0.001).
• RA provided superior pain relief, reducing the need for additional analgesics.
3. Complications:
• The incidence of nausea and vomiting was lower in the RA group (10% vs. 25%, p<0.01).
• Respiratory depression was less common in the RA group (2% vs. 8%, p=0.02).

Fetal Outcomes

1. Apgar Scores:
• Neonates in the RA group had higher Apgar scores at both 1 minute (8.2 ± 1.0 vs. 7.1 ± 1.2, p<0.05) and 5 minutes (9.1 ± 0.6 vs. 8.5 ± 0.8, p<0.05).
• This indicates better neonatal adaptation and vitality in the RA group.
2. Umbilical Cord pH:
• Umbilical cord pH was comparable between the two groups (7.24 ± 0.04 for RA vs. 7.22 ± 0.05 for GA, p=0.45).
• Both techniques provided adequate fetal oxygenation.
3. NICU Admissions:
• Fewer neonates in the RA group required admission to the neonatal intensive care unit (NICU) (8% vs. 15%, p=0.02).
• This suggests a lower risk of neonatal complications with RA.

Key Findings

• RA Advantages:
• Better hemodynamic stability.
• Lower postoperative pain scores.
• Fewer maternal complications (nausea, vomiting, respiratory depression).
• Improved neonatal outcomes (higher Apgar scores, fewer NICU admissions).
• GA Considerations:
• While GA is necessary in emergencies, it is associated with higher rates of maternal complications and poorer neonatal outcomes compared to RA.

Table 1: Maternal Outcomes

Table 2: Fetal Outcomes

This study demonstrates that regional anaesthesia is associated with superior maternal and fetal outcomes compared to general anaesthesia in cesarean deliveries. These findings are consistent with existing literature and provide further evidence to support the preferential use of RA when feasible.

Maternal Outcomes

1. Hemodynamic Stability:
   RA was associated with significantly better hemodynamic stability compared to GA (12% vs. 35%, p<0.01). This is consistent with studies by Hawkins et al. [1], who reported that RA minimizes the risk of hypotension and tachycardia, which are common with GA.
2. Postoperative Pain:
   Postoperative pain scores were significantly lower in the RA group (VAS: 3.8 ± 1.2 vs. 6.2 ± 1.5, p<0.001). This finding aligns with research by Wong et al. [2], which highlighted the analgesic benefits of RA in reducing postoperative pain and opioid consumption.
3. Complications:
   The incidence of nausea, vomiting, and respiratory depression was lower in the RA group, consistent with findings from Patel et al. [3]. These complications are often attributed to the use of opioids and volatile agents in GA.

Fetal Outcomes

1. Apgar Scores:
   Higher Apgar scores at 1 and 5 minutes in the RA group (8.2 ± 1.0 and 9.1 ± 0.6, respectively) suggest better neonatal adaptation. This is supported by studies by Reynolds et al. [4], who found that RA reduces fetal exposure to anaesthetic agents, which can cause neonatal depression.
2. Umbilical Cord pH:
   Umbilical cord pH was comparable between groups (7.22 ± 0.05 vs. 7.24 ± 0.04, p=0.45), indicating that both techniques provide adequate fetal oxygenation. This finding is consistent with research by Malin et al. [5].
3. NICU Admissions:
   Fewer NICU admissions in the RA group (8% vs. 15%, p=0.02) suggest better neonatal outcomes. This is in line with studies by Afolabi et al. [6], who reported that RA reduces the risk of neonatal respiratory distress and other complications requiring intensive care.

Comparison with Existing Literature

The results of this study are consistent with a 2020 meta-analysis by Sng et al. [7], which concluded that RA is associated with better maternal and neonatal outcomes compared to GA. Similarly, a 2019 study by Palanisamy et al. [8] found that RA reduces the risk of maternal hypotension and neonatal depression.

Clinical Implications

The findings of this study support the preferential use of RA for cesarean deliveries, particularly in elective cases. RA not only improves maternal comfort and recovery but also enhances fetal well-being. However, GA remains a necessary option in emergencies or when RA is contraindicated.

Limitations

1. Single-Center Study: The study was conducted at a single tertiary care hospital, which may limit generalizability.
2. Observational Design: The study design precludes establishing causality.
3. Exclusion of High-Risk Cases: The exclusion of women with comorbidities may limit the applicability of findings to high-risk populations.

Future Directions

1. Multicenter Studies: Future research should involve multiple centers to validate these findings in diverse populations.
2. High-Risk Populations: Studies should evaluate the impact of anaesthesia on maternal and fetal outcomes in high-risk pregnancies.
3. Long-Term Outcomes: Research should explore the long-term effects of anaesthesia on maternal and child health.

Regional anaesthesia is associated with improved maternal and fetal outcomes compared to general anaesthesia in cesarean deliveries. These findings underscore the importance of prioritizing RA when feasible, while recognizing the continued role of GA in emergencies. Further research is needed to validate these findings and explore their implications for high-risk populations.

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