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Association of placental weight and the umbilical coiling ındex with early neonatal adaptation in term neonates delivered by elective cesarean section under general anesthesia: a prospective observational study
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DOI：10.1186/s12884-026-09813-8.png)
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Abstract
En 中文
General anesthesia for cesarean delivery may affect early neonatal adaptation, but neonatal condition at birth may also reflect fetoplacental characteristics. This study evaluated associations of placental weight and umbilical coiling index with 1-minute Apgar score and umbilical arterial blood gas parameters in term neonates delivered by elective cesarean delivery under general anesthesia. This single-center prospective observational study included 60 term singleton mother–neonate pairs undergoing elective cesarean delivery under standardized general anesthesia. Placental weight, umbilical cord measurements, umbilical coiling index, birth weight, 1-minute Apgar score, and umbilical arterial blood gas parameters were recorded. Neonates were compared according to Apgar score ≤ 7 or ≥ 8. Correlations were assessed using Spearman analysis. Associations with Apgar ≤ 7 were examined using Firth logistic regression adjusted for birth weight and induction-to-cord-clamping interval. Fourteen neonates had a 1-minute Apgar score of 7, 10 had a score of 8, and 36 had a score of 9; no neonate had a score of ≤ 6. For the binary analyses, scores were categorized as ≤ 7 versus ≥ 8. Placental weight was lower in the Apgar ≤ 7 group than in the Apgar ≥ 8 group (528.0 [456.2–567.5] g vs. 602.5 [546.2–675.0] g; p = 0.004) and remained significant after false discovery rate correction. Umbilical coiling index was also lower in the Apgar ≤ 7 group (0.24 [0.22–0.28] vs. 0.29 [0.23–0.35]; p = 0.025), but not after correction. The 1-minute Apgar score correlated positively with placental weight, umbilical coiling index, umbilical arterial pH, base excess, and bicarbonate. In adjusted models, each 100-g increase in placental weight was associated with lower odds of Apgar ≤ 7 (adjusted OR 0.36, 95% CI 0.12–0.85; p = 0.017), as was each 0.10-unit increase in umbilical coiling index (adjusted OR 0.31, 95% CI 0.09–0.82; p = 0.015). Lower Apgar scores were accompanied by lower pH, base excess, and bicarbonate values, without group-level evidence of severe acidemia. In this small, single-center cohort of term neonates delivered by elective cesarean delivery under standardized general anesthesia, lower placental weight and lower umbilical coiling index were associated with a 1-minute Apgar score of ≤ 7. Given the limited sample size and the small number of neonates in the Apgar ≤ 7 group, these findings should be considered exploratory and hypothesis-generating. Their clinical significance remains uncertain because 5-minute Apgar scores and other clinically important neonatal outcomes were not assessed, and external validation is required before any clinical application.
Keywords:
Anesthesia, General
Apgar Score
Cesarean Section
Newborn
Placenta
Umbilical Cord
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