Caesarean section outcome in eclamptic patients: a comparison of infiltration and general anaesthesia

Eclamptic patients undergoing caesarean delivery present extreme management problems for both obstetricians and anaesthetists. These problems reflect a poor maternal and perinatal outcome.

To determine outcomes following the use of infiltrative anaesthesia (gLA) compared with general anaesthesia (gGA) in eclamptic patients undergoing caesarean section.

Eclamptic patients scheduled for emergency caesarean section were prospectively studied. They were randomised into two groups to receive either infiltration with local anaesthetic or general anaesthesia for caesarean section. The protocol used for this study included clinical and sociodemographic data, chest examination prior to administration of anaesthesia, maternal and perinatal outcome, duration of maternal hospital stay and intraoperative blood pressure measurement.

There were a total of 76 eclamptic patients in the study. There were no significant differences between the infiltration and general anaesthesia groups with regard to clinical and bio-socio-demographic parameters. Fourteen (40.0%) newborns in the gLA had lowerApgar scores in the first minute than 27 (73.0%) in the gGA group. Five (14.3%) newborns were stillbirths in gLA while 2 (5.4%) were found in the gGA. Twenty-one (60.0%) in gLA had Apgar scores e"8 compared to 10 (27.0%) in the gGA. The duration of hospital stay was longer in the gGA (17.1+/-4.1 days) than the gLA (13.0+/-1.6 days) with a statistically significant difference (p<0.0001). There were five (12.5%) maternal deaths in the gGA and two (5.0%) in the gLA. Intraoperatively, the mean arterial pressure and mean systolic pressure at skin incision were consistently and significantly higher in the gGA group than in gLA group.

Local infiltrative anaesthesia appears to have a better maternal and perinatal outcome than general anaesthesia for eclamptic patients undergoing caesarean section.