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Master Thesis

Quel est l’impact des agents anesthésiants administrés à la mère sur l’adaptation à la vie extra-utérine du nouveau-né en salle de naissance ?

Abstract : Background: during pregnancy, mother and childs are connected by the placenta. Any substances administered to the mother can potentially cross the placental barrier and have an impact on the newborn. Cesarean section under general anesthesia exposes the fetus to anesthesia products until the umbilical cord is clamped. Objective: investigate the impact of maternal general anesthesia in the event of an elective cesarean section on the newborn's adaptation to immediate extrauterine life. Material and Method: we conducted an observational, retrospective, multicentric study from 2013 to 2018. Were included women at term (= 37SA), who had an elective caesarean section under general anesthesia. 135 newborns were included in the study. We analyzed the impact of fetal exposure to thiopental, propofol or morphine on the use of tactile stimulation and mechanical ventilation (mask ventilation, intubation). We also evaluated the use of external cardiac massage, adrenaline administration, transfer to the neonatal unit, Apgar at 1, 3, 5 and 10minutes, pH and time between induction and birth. Results: we did not show any difference between newborns exposed to thiopental rather than propofol. Similarly, we did not show any difference between newborns exposed to morphine or not. On the other hand, there is a negative impact on Apgar at 3 minutes when the thiopental dose administered to the mother is > 6mg/kg (p=0.03). Regarding the time between induction and birth of NVN, we showed a decrease in Apgar at 1, 3 and 5 minutes when the time was = 10 minutes (respectively p < 0.001, p = 0.012, p = 0.026). At a threshold of 8 minutes, we find a similar result only on the Apgar at 1 minute (p = 0.003). Conclusion: we have shown that the dose of thiopental received as well as the time of fetal extraction are predictive indicators of the immediate adaptation of the newborn. Whatever drugs are used (thiopental, propofol, opioids), there is no evidence of any difference in the adaptation to the extrauterine life of the newborn. However, a dose effect of thiopental on the occurrence of deleterious effects on the newborn has been demonstrated, which is not the case with propofol.
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Adèle Cordier. Quel est l’impact des agents anesthésiants administrés à la mère sur l’adaptation à la vie extra-utérine du nouveau-né en salle de naissance ?. Gynécologie et obstétrique. 2019. ⟨dumas-02309963⟩

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