With PAH, Local Anesthesia Better Than General for Mother and Baby

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by Margarida Maia PhD |

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pregnancy with PAH | Pulmonary Hypertension News | illustration of pregnant woman

C-section in PAH

Local anesthesia is better than general anesthesia for both the mother and her baby when delivery is by cesarean section (C-section) and the woman has pulmonary arterial hypertension (PAH), a study suggests.

These findings might help to guide doctors in selecting the best approach to anesthesia for women in labor.

The study, “Effects of different anesthesia methods on maternal and neonatal outcomes in pregnant patients with pulmonary arterial hypertension: a meta-analysis,” was published in the Archives of Gynecology and Obstetrics.

PAH symptoms are associated with a lack of oxygen in the blood that is caused by reduced blood flow to the lungs, meaning that the heart needs to work harder than normal to meet the body’s demands for oxygen.

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Pregnancy puts the heart and the blood vessels under even more strain, and this brings specific risks to women with PAH and their babies.

While current guidelines do not recommend a pregnancy with PAH, more experience is being gained in managing PAH in women going into labor.

Ideally, a woman with PAH should not go into labor naturally, because a prolonged delivery can further increase pressure in the blood vessels that supply the lungs.

A C-section may be recommended as a planned procedure to avoid some of the complications of an often lengthy natural delivery. During the procedure, the woman may be put to sleep with general anesthesia or remain awake with local anesthesia that numbs only the lower part of the body.

A team of researchers in China investigated “the effects of different anesthesia methods on maternal and neonatal outcomes in pregnant patients with pulmonary arterial hypertension (PAH),” they wrote.

Using an analysis method that combines the results of multiple studies, the researchers collected information from a total of 18 scientific articles. These articles had data covering 1,109 patients, of whom 628 (56.6%) underwent a C-section using local anesthesia and 481 (43.4%) under general anesthesia. The team compared a range of mother and baby outcomes between the two groups.

Women who were put under local anesthesia had half the odds of dying after giving birth, compared with those under general anesthesia, results showed.

Oxygen saturation, which is a measure of the amount of oxygen being carried in red blood cells through the body, was lower in women given local anesthesia than in those who had general anesthesia.

After delivery, both the systolic blood pressure (the pressure in the arteries when the heart beats and fills them with blood) and the diastolic blood pressure (the pressure in the arteries when the heart rests between beats) were higher in women who were put under local anesthesia.

“Previously, a study has indicated that LA [local anesthesia] can avoid a rapid decrease in systemic vascular resistance (SVR) … to ensure the hemodynamic stability during the surgery,” the researchers wrote, adding this finding “supported the conclusion of our study.”

The time needed on mechanical ventilation to assist with breathing was shorter for women put under local anesthesia, as was the length of stay in a hospital and in an intensive care unit (ICU).

No significant differences were seen regarding neonatal asphyxia rate and neonatal mortality rate between the two groups. However, “this might be caused by the limited numbers of articles with small sample size included in our study,” the researchers noted.

Based on these findings, the team concluded that local anesthesia appears to be superior to general anesthesia for multiple outcomes after a C-section in women with PAH.

“In conclusion, [local anesthesia] presented more efficacy in pregnant patients with PAH in postoperative blood oxygen saturation, postoperative systolic blood pressure, postoperative diastolic blood pressure, mechanical ventilation time, ICU admission time, length of stay and the maternal mortality rate than [general anesthesia],” the researchers wrote.

“The results of our study might offer a reference for clinicians to select proper anesthesia methods for pregnant patients with PAH,” they added.

Nonetheless, well-designed studies with larger patient sizes are needed to confirm these findings, the researchers noted.