Birth Asphyxia during General Anesthesia for a Morbidly Obese Parturient with Gestational Diabetes Mellitus Undergoing Cesarean Section-A Case Report

一位合併有妊娠性糖尿病的過度肥胖產婦在全身麻醉下接受剖腹生產時發生初生嬰兒窒息－病例報告

鄭鴻鈞(Hung-Chun Cheng) ； 陳坤堡(Kuen-Bao Chen) ； 劉玉成(Yu-Cheng Liu) ； 吳世銓(Rick Sai-Chuen Wu)

《Acta Anaesthesiologica Taiwanica》 45卷1期 (2007/03) Pp. 53-57

摘要

一位26歲體重指數60的產婦被安排接受剖腹生產。產婦在懷孕17週即有妊娠性糖尿病及高血壓。血糖在胰島素治療下，維持在110-140毫克／分公升。血壓在藥物控制下維持收縮壓在140-180毫米汞柱之範圍。產前超音波顯示有臍動脈灌流不足的情形。手術過程採行全身麻醉。可惜嬰兒出生時，有不呼吸與較低的Apgarscores，一開始全身麻醉的藥物被認為是致病原因。經過一系列檢查與治療,低血糖及胎盤功能不良被認為是導致發生的主要原因。48小時之後，嬰兒的情況即得到顯著的改善。

關鍵字

剖腹產 ； 新生兒窒息 ； 妊娠糖尿病 ； 新生兒 ； 低血糖

並列摘要

A 26-year-old pregnant woman with a body mass index of 60 was scheduled for cesarean section at 36 weeks' gestation. She was found having affected with gestational diabetes mellitus and hypertension at 17 weeks of pregnancy. The blood glucose level as controlled by subcutaneous injection of insulin was maintained at the level of 110-140mg/dL. Hypertension was also controlled bymethyldopa and hydralazine with the systolic pressuremaintaining at 140-180 mmHg during the pregnancy. Abnormal perfusion of umbilical artery without compromise of placental function was found twice by Doppler prenatal examination at gestation of 33 and 34 weeks respectively. The operation was performed under general anesthesia. However, apnea and low Apgar score of the neonate were noted. General anesthesia was thought as the root cause of this event at first. After a series of examination and management, hypoglycemia and uteroplacental perfusion insufficiency were considered as the causes of this morbidity. The neonate's condition was improved in 48 hr after close care.

並列關鍵字

Cesarean section ； Asphyxia neonatorum ； Diabetes, gestational ； Infant, newborn ； Hypoglycemia