A retrospective study to correlate breech presentation and enhanced risk of postspinal hypotension during cesarean delivery

Abstract

BackgroundSubarachnoid blockade for cesarean section still poses a threat of profound hypotension and can result in unstable maternal and fetal hemodynamics. The correlation of fetal breech and vertex presentation with the occurrence of hypotension under spinal anesthesia is reviewed in this retrospective, double-blind study.Patients and methodsThe study was conducted on pregnant females scheduled for a lower segment cesarean section between January 2014 and December 2014. After applying inclusion criteria, 568 patients were recruited in the study out of which 363 had vertex and 184 patients had breech presentation. They were divided into two groups, Group I and Group II. The monitoring and therapeutic data (blood pressure, heart rate, arterial oxygen saturation, and dose of vasopressor/atropine) recovered from automated data analysis were analyzed retrospectively for prevalence of hypotension, bradycardia, and hypotension with bradycardia and nausea ± vomiting.ResultsAmong Group I, prevalence of hypotension, bradycardia, and hypotension together with bradycardia was 152 (41.83%) patients, eight (2.20%) patients, and seven (1.92%) patients, respectively. In Group II, the prevalence of hypotension, bradycardia, and hypotension with bradycardia was 93 (50.5%) patients, five (2.71%) patients, and six (3.2%) patients, respectively. The difference between the two groups was statistically significant for hypotension. For Group I, 152 patients (41.87%) experienced one, 23 patients (6.33%) experienced two, and three patients (0.82%) experienced three episodes of hypotension. In Group II, 93 (50.5%), 19 (7.89%), and two (1.08%) patients experienced such episodes. The difference was significant with respect of one and two episodes. The prevalence of intraoperative nausea was 11.01% (40 patients) in Group I, whereas 11.41% (21 patients) in Group II. Intraoperative vomiting occurred in 19 patients (5.23%) of Group I and 14 patients (7.60%) of Group II. The height of the block was comparable in both the groups for T6, and the difference was significant in respect to T4 level.ConclusionIncidence of hypotension is more in pregnant females with breech fetal presentation.

The effect of preoperative anxiety on phenylephrine dose during cesarean delivery: An open controlled one‐arm clinical trial

“…First of all, post‐spinal hypotension is also influenced by other factors besides anxiety. A previous study has shown that parturients with breech presentation had a higher incidence of post‐spinal hypotension 16 . Neonatal weight, maternal age, and peak sensory block height have also been shown to influence the incidence of post‐spinal hypotension 17 .…”

“…A previous study has shown that parturients with breech presentation had a higher incidence of post-spinal hypotension. 16 Neonatal weight, maternal age, and peak sensory block height have also been shown to influence the incidence of post-spinal hypotension. 17 Furthermore, increased pregnancy weight-gain, history of hypotension, baseline systolic blood pressure <120 mm Hg, and a baseline heart rate >100 beats per minute were found to have an influence on the frequency of spinal-hypotension.…”