Hypertension
Poster Session 1
Minhazur R. Sarker, MD (he/him/his)
Fellow
University of California San Diego
San Diego, CA, United States
Daniella Rogerson, MD, MS (she/her/hers)
Resident
UC San Diego
San Diego, CA, United States
Jenny B. Koenig, MD, PhD
UC San Diego
San Diego, CA, United States
Lauren Ferrara, MD
Mount Sinai School of Medicine
New York, NY, United States
Angela Bianco, MD
Attending Physician
Mount Sinai Medical Center
New York, NY, United States
Gladys A. Ramos, MD
Clinica Professor
University of California, San Diego
San Diego, CA, United States
Chelsea A. DeBolt, MD
MFM Fellow
Mount Sinai Hospital
New York, NY, United States
Maternal hypotension is a common complication of neuraxial anesthesia, and maternal hypotension has been associated with fetal acidemia. We aimed to determine if pregnancies with hypertensive disorders (HDP) that experienced acute post-neuraxial hypotension were associated with fetal acidemia.
Study Design:
Retrospective cohort study of non-labor, term, singleton, non-anomalous births via cesarean delivery under neuraxial anesthesia from 2013-2019 that experienced acute post-neuraxial hypotension (systolic blood pressure < 100 mmHg recorded prior to delivery). We compared rates of adverse outcomes in pregnancies with or without HDP defined as gestational hypertension, chronic hypertension, and pre-eclampsia without severe features. Primary outcome was umbilical artery pH < 7.1. Secondary outcomes included umbilical artery pH < 7.2, umbilical cord base deficit of > 8, umbilical cord base deficit of > 12, 5-minute APGAR < 7, neonatal intensive care unit (NICU) admission, and meconium-stained amniotic fluid. Chi-square and multivariate regression tests determined the strength of association.
Results:
Of 2851 included subjects, 189 (6.63%) had an HDP while 2662 (93.37%) did not. Pregnancies with HDP had higher BMI, higher rates of diabetes, more often received combined spinal-epidural analgesia, and had longer procedural time from neuraxial placement to delivery (all p < 0.01). After adjusting for confounders including maternal BMI, type of neuraxial anesthesia, and time from neuraxial anesthesia to delivery, pregnancies complicated by HDP with acute post-neuraxial hypotension were associated with umbilical artery pH < 7.1 (aOR 1.75; 95% CI 1.02-3.06) and umbilical cord base deficit >8 (aOR 1.76; 95% CI 1.04-2.98).
Conclusion:
Findings suggest that among pregnancies that experience an acute post-neuraxial hypotensive episode, those complicated by HDP are associated increased odds of fetal acidemia compared to normotensive pregnancies. Further studies are needed to better determine the effect of hypotensive insult on fetal academia in pregnancies complicated by HDP.