제왕절개 수술을 받는 쌍태임신 산모와 단태임신 산모 간 척추 마취 중 저혈압 발생율 및 승압제 요구량의 비교

Abstract

Introduction: Spinal anesthesia (SA) is a preferred and widely used anesthetic method for cesarean delivery (CD). However, maternal hypotension is a common side effect during SA. With the development of assisted reproductive technologies, the number of multifetal pregnancies has recently increased. Nevertheless, there are only a few studies investigating complications including hypotension associated with SA during CD for multifetal pregnancy. The aim of our study is to compare hypotension incidence and vasopressor requirement in parturients with twin versus singleton pregnancies during SA for elective CD. Methods: Pregnant women undergoing SA for elective CD between June 2022 and December 2022 were enrolled in this study. On arrival in the operating room, all parturients underwent standard monitoring. Their baseline parameters were recorded in the supine position before SA. SA was performed using hyperbaric 0.5% bupivacaine 8 mg with fentanyl 15mcg. The blood pressure was automatically measured non-invasively at 1-minute intervals as the established protocol after SA. If hypotension, defined as a drop in systolic blood pressure (SBP) to <80% of baseline SBP, occurred, intravenous (IV) phenylephrine 100 mcg was administered. If the blood pressure did not increase to ≥80% of the baseline SBP despite repeated administration of 100 mcg of phenylephrine, the dose of phenylephrine was increased to 200 mcg. Results: We analyzed 111 parturients with singleton pregnancy and 55 parturients with twin pregnancy. There was no significant difference between the two groups in the patient characteristics except for two variables, gestational age and the sum of total birth weight of the newborns. There was a significant difference in SBP between the two groups over time (p = 0.023), namely, SBP 5 minutes after SA was significantly lower in the singleton group than in the twin group (100 ± 17 vs. 108 ± 19, p = 0.014). Hypotension immediately before delivery was observed in 77 of 111 (69.4%) women with singleton pregnancy and in 35 of 55 (63.6%) women with twin pregnancy (p = 0.458). No differences in the use of phenylephrine were observed between the two groups. Conclusions: The incidence of hypotension and the amount of vasopressor required during SA in twin pregnancies were not significantly different from those of singleton pregnancies. There are few studies related to the use of vasopressors in twin pregnancy during SA. Our findings could help develop a strategy for preparing for hypotension while supporting the appropriate use of limited medical resources.