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OBSTETRIC ANESTHESIA

The Anesthetic Management of Triplet Cesarean Delivery: A Retrospective Case Series of Maternal Outcomes

Teresa Marino, MD^*, Leonidas C. Goudas, MD PhD, Valery Steinbok, MD, Sabrina D. Craigo, MD^*, and Ralph W. Yarnell, MD

*Division of Maternal-Fetal-Medicine and Department of Anesthesia, New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts

Address correspondence and reprint requests to Teresa Marino, MD, Division of Maternal-Fetal-Medicine, New England Medical Center, 750 Washington, Box 360, Boston, MA 02111. Address e-mail to tmarino{at}lifespan.org

Spinal anesthesia for the cesarean delivery of triplets is associated with an increased incidence of maternal hypotension and placental hypoperfusion. We performed a retrospective case series analysis between January 1992 and June 2000 to evaluate the effects of regional anesthetic techniques for cesarean delivery in triplet pregnancies on maternal and neonatal outcome. Spinal and epidural anesthesia were compared with respect to intraoperative hemodynamics and neonatal outcomes. Ninety-six triplet pregnancies were delivered by cesarean section, of which 91 received regional anesthesia. A statistically significant decrease in systolic blood pressure was demonstrated immediately after the induction of spinal as compared with epidural anesthesia. The total volume of IV crystalloid used was significantly larger in the Spinal Anesthesia group. The number of patients receiving more than 15 mg of ephedrine and the cumulative dose of ephedrine was significantly larger in the Spinal group compared with the Epidural group. There were no differences in the rate of perioperative complications between the Spinal and Epidural Anesthesia groups. Neonatal Apgar scores were similar in both groups. The data suggest that both epidural and spinal anesthesia for triplet cesarean delivery are safe techniques, but the latter is associated with a larger initial decrease in systolic blood pressure. This decreasing of systolic blood pressure, however, remained within the physiological range and did not seem to be clinically significant. The need for more crystalloid fluids and ephedrine should be anticipated when spinal anesthesia is used for these cases.

IMPLICATIONS: A large retrospective case series of the effects of spinal and epidural anesthesia on maternal hemodynamic profile during cesarean delivery for triplet gestation was performed. Our findings suggest that spinal anesthesia results in outcomes comparable to epidural anesthesia for both mother and newborns.

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