title: Maternal pulse oximetry perfusion index as a predictor of early adverse respiratory neonatal outcome after elective cesarean delivery.
abstract: OBJECTIVE
  Evidence suggests increased morbidity, in particular early neonatal respiratory complications, in newborns from elective cesarean section compared with those from vaginal delivery. No reliable maternal predictors of adverse neonatal outcome at elective cesarean section are known. Here, we prospectively tested the hypothesis that a low maternal perfusion index at the baseline phase (i.e., preanesthesia) of the elective cesarean section is a predictor of early adverse neonatal respiratory outcome.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Operating and delivery rooms of a public health hospital with a tertiary-level neonatal intensive care unit.
  
  
  METHODS
  Forty-four healthy pregnant women with no known risk factors undergoing elective cesarean section at term gestation.
  
  
  METHODS
  Elective cesarean section was divided into nine phases. Analysis of pulse oximetry-derived signals (perfusion index, pulse rate, and oximetry) and systolic, diastolic, and differential blood pressure were recorded. Maternal arterial and venous newborn cord blood gas analyses and placental histology were evaluated.
  
  
  RESULTS
  Early respiratory complications (transient tachypnea of the newborn, n = 5; respiratory distress syndrome, n = 1) were observed in 13.6% (6 of 44) of the newborns. A maternal perfusion index < or = 1.9 (lower quartile) during the preanesthesia phase of the elective cesarean section was an independent predictor of early adverse neonatal respiratory outcome (odds ratio 68.0, 95% confidence interval 6.02-767.72; p < .0001).
  
  
  CONCLUSIONS
  A decreased perfusion index value in the preanesthesia phase of elective cesarean section is a maternal predictor of increased neonatal morbidity and is significantly related to subclinical placental inflammatory disease. These observations suggest the feasibility of a noninvasive pulse oximeter prenatal screening of the high-risk fetus/newborn in elective cesarean section.
authors.affiliation: Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy. defelice.claudio@libero.it
authors.forename: Claudio
authors.initials: C
authors.lastname: De Felice
authors.forename: Licia
authors.initials: L
authors.lastname: Leoni
authors.forename: Enrica
authors.initials: E
authors.lastname: Tommasini
authors.forename: Gabriele
authors.initials: G
authors.lastname: Tonni
authors.forename: Paolo
authors.initials: P
authors.lastname: Toti
authors.forename: Antonio
authors.initials: A
authors.lastname: Del Vecchio
authors.forename: Grazia
authors.initials: G
authors.lastname: Ladisa
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Latini
mesh_terms: D000328:Adult; D001784:Blood Gas Analysis; D001794:Blood Pressure; D002585:Cesarean Section; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007558:Italy; D008297:Male; D017063:Outcome Assessment, Health Care; D010092:Oximetry; D010100:Oxygen / Q000032:analysis*; D011379:Prognosis; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000175:diagnosis*
chemical_list: D010100:Oxygen