Predictors of Maternal, Neonatal, and Clinicopathological Factors Associated with Postoperative Complications Following Emergency Cesarean Section Under General Anesthesia: A Retrospective Cohort Study

Abstract

Background: Emergency cesarean section under general anesthesia is associated with increased maternal and neonatal risk because of underlying obstetric emergencies, maternal comorbidities, and anesthesia-related physiological changes. Perioperative predictors may facilitate risk stratifications, preparedness, and multidisciplinary intervention in a timely manner. This study evaluated maternal, anesthetic, operative, clinicopathological, and neonatal predictors of adverse outcomes.

Materials and Methods: This retrospective cohort study included 120 women who underwent emergency cesarean section under general anesthesia from January 2022 to January 2023. Demographic, obstetric, laboratory, anesthetic, operative, postoperative and neonatal data were examined. Independent predictors for maternal postoperative complications and adverse neonatal outcomes were determined by utilizing multivariable logistic regression with a statistical significance of p<0.05.

Results: The mean maternal age was 29.6 ± 5.1 years. The overall incidence of at least one postoperative complication was 41 women (34.2%) and adverse outcome was 39 neonates (32.5%). Postpartum hemorrhage (14.2%), intensive care admission (7.5%) and neonatal intensive care admission (22.5%) occurred in the respective patients. Preoperative hemoglobin level less than 10 g/dL, ASA physical status III–IV, estimated blood loss more than 1000 mL, and operative time greater than 60 minutes were independently associated with maternal complications. Adverse neonatal outcomes were independently associated with prematurity, maternal intraoperative hypotension, and an induction-to-delivery interval >10 minutes.

Conclusion: Emergency cesarean delivery (under general anesthesia) is associated with significant maternal and infant morbidity. Early identification of risk, correction of anaemia, emergency haemorrhage preparedness, haemodynamic optimization and induction-to-delivery delay reduction may result in better outcomes peroperatively and safer emergency obstetric care.

Keywords: Cesarean section; General anesthesia; Maternal complications; Neonatal outcomes; Postpartum hemorrhage; Obstetric anesthesia; Risk factors.