Comparison of Apgar Scores and Umbilical Vein Oxygen Saturation Among Neonates Who’s Mothers Had Spinal Anaesthesia for Elective Caesarean Delivery With Either Supplemental Oxygen or Room Air

Abstract

Background During spinal anaesthesia for caesarean delivery, some anaesthesia practitioners do not administer supplemental oxygen routinely to low-risk mothers. Benefits of maternal oxygen supplementation on both the foetus and neonate remain questionable. Recent data has raised concerns, that supplemental oxygen may cause harm to both the mother and the baby due to increased free radical activity(1). In this cross-sectional comparative study, we assessed if there was any association between foetal outcomes as measured by the Apgar score and maternal oxygen levels during elective caesarean delivery under spinal anaesthesia. Broad Objective The main objective of this study was to compare the Apgar scores and umbilical vein oxygen saturation among neonates of term low-risk pregnant mothers who had spinal anaesthesia for elective caesarean delivery with either supplemental oxygen or room air. Study Methodology The study adopted a comparative cross-sectional study design and was carried out at the maternity theatre in Kenyatta National Hospital. The target population consisted of pregnant women at term scheduled for elective caesarean delivery under spinal anaesthesia. Over a period of 1.5 months, 80 term pregnant women were enrolled into the study by consecutive sampling method. Spinal anaesthesia was administered to equivalent dermatomal levels in all patients as per current KNH protocol. It was purely an observational study, where patients either fell into group A or group B. Patients in group A are the ones who had been provided with supplemental oxygen via nasal prongs at 2 litres per minute after spinal block, while group B are those who had been on room air after spinal block. Time of spinal administration, drug used, and the dose were recorded on the data collection tool. Data Analysis Data was entered, and analysis done using Statistical Package for Social Sciences (SPSS) version 21. Continuous data was analysed and presented as means and standard deviation, while categorical data was analysed and presented as frequencies and proportions. A comparison of the clinical outcomes and the saturation levels of umbilical venous oxygen between the two groups was done using Chi square test of association for categorical data while the differences in means of umbilical venous oxygen saturation were done using two sample students t test. A P value of < 0.05 was considered significant.

Results In group A, the value of Apgar score at one minute varied from 7 to 9, at five minute it was from 8 to 10 and, at ten minute it was from 9 to 10. While in group B, the results of Apgar score were same with no statistically significant difference (P>0.05). The difference in values of SuvO2 in group A vs group B [mean 38.5 (19.8) vs 33.5 (15.3)] as well, was found not to be statistically significant. Conclusion Provision of supplementary oxygen to term low-risk pregnant mothers undergoing elective caesarean delivery has no significant difference on the outcomes of neonates as far as their Apgar scores, umbilical vein blood gas and acid-base status is concerned. Therefore, there is no maternal indication for routine oxygen supplementation in low-risk mothers undergoing elective caesarean delivery under spinal anaesthesia.