Anaesthesia for caesarean section and postpartum cardiovascular events
in congenital heart disease: a retrospective cohort study
Abstract
Objective To clarify the association between anaesthetic
technique and maternal and neonatal outcomes in parturients with CHD.
Design Retrospective observational cohort study.
Setting Academic hospital. Population A total of 263
consecutive parturients with congenital heart disease (CHD) who
underwent caesarean section. Methods Charts from 1994–2019
were reviewed. Main outcome measures We compared postpartum
cardiovascular events (composite of heart failure, pulmonary
hypertension, arrhythmia, and thromboembolic complications) and neonatal
outcomes (intubation and Apgar score <7 at 1 or 5 minutes) by
anaesthetic technique. Results Among 263 caesarean sections,
general anaesthesia was performed in 47 (17.9%) parturients and
neuraxial anaesthesia in 214 (81.3%) parturients. Cardiovascular events
were more common in the general anaesthesia group (n=7; 14.9%) than in
the neuraxial anaesthesia group (n=17; 7.9%). Generalized linear mixed
models assuming a binomial distribution (i.e., mixed-effects logistic
regression) with a random intercept for each modified World Health
Organization classification for maternal cardiovascular risk revealed
that general anaesthesia is not significantly associated with
cardiovascular events (odds ratio [OR], 1.00; 95% confidence
interval [CI], 0.30–3.29). In addition, general anaesthesia was
associated with composite neonatal outcomes (Apgar score <7 at
1 or 5 minutes or need for neonatal intubation; OR, 13.3; 95% CI,
5.52–32.0). Conclusion Anaesthetic technique is not
significantly associated with postpartum composite cardiovascular
events. General anaesthesia is significantly associated with increased
need for neonatal intubation and lower Apgar scores. Funding No
external funding was used in the conduct of this study.
Keywords Anaesthesia, caesarean section, postpartum,
cardiovascular events, congenital heart disease, neonatal outcomes