Results
C-Section2
The ETAPPH study enrolled 421 women, 364 women had spinal anesthesia and 57 had general anesthesia during elective cesarean Sect. (10 records were not included as data on apgar scores at 1 and five minutes was missing). Figure 
Participant flow diagram
Characteristics of Mothers Having Elective Cesarean SectionAgeLess than or equal to 23 years24–34 years35 + years7 (12.3%)36 (63.1%)14 (24.6%)68 (18.7%)210 (57.7%)86 (23.6%)AnemiaNot anemicAnemic33 (97.1%)1 (2.9%)285 (95.6%)13 (4.4%)0.4(Fischer’s exact)BreechNo Breech PresentationBreech Presentation49 (86.0%)8 (14.0%)331 (90.9%)33 (9.1%)Previous Cesarean SectionsNoneOne C-SectionTwo-Five C-Sections26 (45.6%)18 (31.6%)13 (22.8%)143 (39.3%)137 (37.6%)84 (23.1%)Comorbid ConditionNo Comorbid conditionAt least one other condition53 (94.7%)3 (5.3%)342 (94.5%)20 (5.5%)Gestation38 weeks39 weeks>= 40 weeks13 (22.8%)19 (33.3%)25 (43.9%)149 (40.9%)103 (28.3%)112 (30.8%)HIV StatusNegativePositive49 (87.5%)7 (12.5%)297 (85.1%)52 (14.9%)Table 
Covariate Distribution by Anesthesia Administration after IPTWAgeLess than or equal to 23 years24–34 years35 + years52 (16.0%)196 (59.7%)80 (24.3%)59 (18.5%)185 (58.3%)74 (23.2%)AnemiaNot anemicanemic319 (97.2%)9 (2.8%)304 (95.6%)14 (4.4%)BreechNo Breech PresentationBreech Presentation293 (89.5%)35 (10.5%)284 (89.2%)34 (10.8%)Previous Cesarean SectionsNone1 C-Section2 to 5 C-Sections149 (45.4%)115 (35.2%)64 (19.4%)128 (40.3%)115 (36.2%)75 (23.5%)Comorbid ConditionNo Comorbid conditionAt least one other condition322 (98.3%)6 (1.7%)307 (96.6%)11 (3.4%)Gestation38 weeks39 weeks>= 40 weeks167 (50.9%)82 (25.1%)79 (24.0%)129 (40.6%)91 (28.6%)98 (30.8%)HIV StatusNegativePositive284 (86.6%)44 (13.4%)275 (86.4%)43 (13.6%)We carried out a MSM analysis to assess the relationship between infant apgar scores at five (1) and five (5) minutes using adjusted odds ratio (
Adjusted Estimates After a Marginal Structural Logistic Model AnalysisAnesthetic AdministrationGeneral (baseline) vs. Spinal AnesthesiaaOR = 4.0,95% CI = 1.5 to 10.7,p-value = 0.006aOR = 6.2,95% CI = 1.6 to 23.1,p-value = 0.007aOR = 1.2395% CI = 0.6 to 2.7p-value = 0.4aOR = 0.795% CI = 0.2 to 1.8p-value = 0.4