General versus spinal anaesthesia for elective caesarean sections: effects on neonatal short-term outcome. A prospective randomised study

Objective. To compare neonatal short-term outcome in patients who underwent spinal, general anaesthesia and conversion from spinal to general anaesthesia. Methods. One hundred seventy-nine pregnant women undergoing elective caesarean section were allocated randomly to general (n = 89) or spinal anaesthesia (n = 90) and compared with 63 patients who required conversion to general anaesthesia. Umbilical cord artery pH, Apgar score as well as its individual parameter and need for assisted ventilation were evaluated. Results. No differences were found in pH values (p - 0.35), while the need for assisted ventilation differed significantly (p = 0.001). The rate of depressed newborns was 1.1% in the spinal group, 25.9% in the general group and 12.7% in the conversion group with a significant difference for all comparisons. At 5-min, all newborns were vigorous. At 1 min, a higher score for each parameter was found in spinal group with respect to general group, while 'activity', 'grimace' and 'respiration' showed a higher score in conversion group than in general group. At 5 min, a difference was found only for 'activity'. Conclusions. All kinds of anaesthesia seem to be safe, but loco-regional blockade shows more advantages on the neonatal outcome also when a conversion is necessary.