Uticaj načina porođaja i vrste akušerske anestezije na oksidativni stres i komplikacije kod novorođenčadi i porodilja
The effect of mode of delivery and type of obstetric anesthesia on oxidative stress and complications infant and maternal
Чланови комисијеPopović, Vladan
МетаподациПриказ свих података о дисертацији
Introduction: birth, although a physiological act, it is followed by the stress response from mothers and newborns. The mode of delivery and the type of obstetrical anesthesia may affect the level of oxidative stress. Uncomplicated vaginal delivery exposes mothers and newborns to a state of increased oxidative stress. Ending the pregnancy by cesarean section has become more common, and the modem spinal anesthesia is preferred to obstetric anesthesia. Direct effects of anesthesia on neonatal outcome, complications related to the birth and the newborn, as well as the oxidative stress that occurs during childbirth, have not been not studied in our community. The activity of the GPx enzyme in infants at birth has been insufficiently addressed in the professional written material it the world in general, and in pregnant women it is unknown. Aim: To determine the effect of mode of delivery and the type of obstetric anesthesia at the level of oxidative stress and complications in newborns and... mothers. Methods: A prospective clinical study was conducted at the Department of Gynecology and Obstetrics, Clinical Center of Vojvodina in Novi Sad. The study included 150 healthy, term infants, delivered by a planned cesarean section with general or spinal anesthesia, as well as in a natural way, and their 150 mothers. Depending on the mode of delivery and the type of obstetric anesthesia, the newborns and mothers were divided into six groups of 50. In all six tested groups, venous blood samples were taken a few minutes after the birth, together with certain laboratory markers of oxidative stress (TBARS and GPx), lactate and gas analysis. The general condition and potential complications of the newborns and mothers during childbirth and hospitalization were monitored and evaluated. Results: The values of Apgar score after 1 and 5 minutes were significantly higher (p < 0.01) in infants who were born by cesarean section under spinal anesthesia . The highest concentration of TBARS and the lowest concentration of GPx were present in infants who were born naturally. The lowest TBARS values had newborns and their mothers from the group of spinal anesthesia, while the concentration of GSH was highest in the group of general anesthesia. The newborns had higher values of markers of oxidative stress than their mothers. The most common complications were maternal hypotension in spinal and general anesthesia in PDPH. Statistically, a significantly (p < 0.001) higher postpartum pain was experienced by the mothers who delivered their babies naturally and the lowest by those who gave birth by caesarean section under spinal anesthesia. Conclusions: The markers of oxidative stress, clinical and laboratory parameters in newborns and mothers, indicate the advantages of the electoral caesarean section over a natural birth, and those of spinal anesthesia over general anesthesia.