Time from neuraxial anesthesia placement to delivery is inversely proportional to umbilical arterial cord pH at scheduled cesarean delivery

Abstract Background Neuraxial block-related hypotension and maternal obesity contribute to uterine hypoperfusion and decreased umbilical arterial pH at cesarean delivery. Between the time of anesthesia placement and delivery, the fetus may be exposed to a hypo-perfused uterine environment without surgeon awareness of fetal compromise. Objective We sought to evaluate neonatal umbilical arterial pH according to pre-delivery time intervals at scheduled term cesarean. Study Design We performed a retrospective cohort study of cesarean deliveries between September 2014 and February 2017. Singleton gestations undergoing scheduled cesarean delivery under spinal anesthesia between 37-41 weeks with a reassuring preoperative non-stress test were included. Time intervals between operative room (OR) entry, spinal anesthesia placement, skin incision, uterine incision, and delivery were calculated. The primary outcome was umbilical arterial pH. Demographic data, maternal blood pressures, pre-delivery time intervals, and delivery outcomes were analyzed according to umbilical arterial pH intervals of 7.30. Umbilical cord gas analytes and neonatal outcomes were analyzed by spinal to delivery time. Stepwise linear regression was performed to identify predictors of decreasing umbilical arterial pH. Receiver operator characteristic curves were calculated for spinal to delivery time and umbilical arterial pH Results Among 527 included participants, median umbilical arterial pH was 7.27 [IQR 7.23-7.29] and body mass index (BMI) was 35 kg/m 2 [IQR 30-41]. Both maternal BMI and hypotensive episodes increased with decreasing umbilical arterial pH (p 2 of 0.157. When evaluated by spinal to delivery time, both umbilical arterial and venous pH and pCO 2 decreased (p Conclusion Longer spinal to delivery and uterine incision to delivery time intervals were associated with decreasing umbilical arterial pH at scheduled term cesarean delivery. Efforts to minimize pre-delivery time following spinal placement could reduce the frequency of unanticipated neonatal acidemia.