Association of hemodynamics during caesarean section, outcomes after caesarean section and hormone changes with different anesthesia in pregnant women with severe pulmonary arterial hypertension

Abstract

In the present study we aimed to analyze the effects of different anesthesia methods on the hemodynamics of caesarean section, outcomes after caesarean section and hormone changes in pregnancy complicated with severe pulmonary arterial hypertension (PAH). A total of 75 pregnancy complicated with severe PAH that were treated in Jining First People's Hospital from January 2016 to January 2017 were selected. Three groups were set according to the anesthesia methods, including the subarachnoid combined epidural anesthesia group (group I, n=25), the epidural anesthesia group (group II, n=25) and the general anesthesia group (group III, n=25). Effects on the outcomes of caesarean section of pregnancy complicated with PAH were observed. Sex hormone levels before and 24, 48 and 72 h after the operation were measured. There were remarkable changes in the postoperative hemodynamics compared with those before anesthesia, but changes in groups I and II were significantly smaller than those in group III (P<0.05). No significant differences in maternal mortality rate, neonatal mortality rate and neonatal asphyxia rate among the three groups were found (P>0.05). Time of postoperative mechanical ventilation, ICU residence and hospitalization in groups I and II were shorter than those in group III, the differences were statistically significant (P<0.05). Postoperative levels of sex hormones, including estradiol (E2), human chorionic gonadotrophin (HCG), prolactin (PRL) and plasma total testosterone (TT) decreased, while postoperative levels of sex hormones follicle stimulating hormone (FSH), luteinizing hormone (LH) and progestogen increased, and differences in the decreased E2 and TT at each time-point were statistically significant (P<0.05). In conclusion, there is no remarkable difference in the effects of three anesthesia methods on pregnancy outcomes. However, compared with general anesthesia, intravertebral anesthesia achieve shorter time of postoperative mechanical ventilation, ICU residence and hospitalization in pregnancy complicated with severe PAH, which is preferred in pregnancy without contraindication of the anesthesia.