Comparis on of Crystalloid Preloading and Crystalloid Coloading in Emergency Caesarean Section for Fetal Distress: A Prospective Study

Abstract

Spinal anesthesia is widely used for emergency and elective C/S delivery. However its main drawback is hypotension which may cause nausea, vomiting and cardiovascular collapse and loss of consciousness in mother as well as fetal hypoxia and acidosis due to placental hypo perfusion. AIMS AND OBJECTIVE: To compare the incidence of hypotension in intraoperative period and to compare the fetal outcome in two groups (Preloading and co loading group). STUDY DESIGN: Prospective randomized double blind study. MATERIALS AND METHOD: This study was conducted in the obstetric emergency OT of Malda Medical College. 100 primi gravid mothers aged between 18-29 years with ASA-1 physical status posted for emergency C/S for fetal distress was randomly allocated for either preloading (Group P) or co loading (Group C). RESULT AND ANALYSIS: Fluid requirement is significantly less in group C. There was no significant difference in the incidence of hypotension and ephedrine use. Fetal outcome in 1 min Apgar score in group C is significantly better as the baby could be delivered quickly in group C. CONCLUSION: Our study revealed that preloading can be safely avoided for spinal anesthesia in C/S for fetal distress. By using co loading method we can save valuable time required to deliver the baby and avoid circulatory overload without increasing the incidence of hypotension.

Crystalloid Coload Reduced the Incidence of Hypotension in Spinal Anesthesia for Cesarean Delivery, When Compared to Crystalloid Preload: A Meta-Analysis

“…In these studies, hypotension was defined as a 20% decrease from baseline in MAP or SBP, or SBP < 90 mmHg. Seven studies [ 11 , 12 , 15 – 18 , 21 ] used ephedrine to treat intraoperative hypotension, two studies [ 14 , 19 ] used ephedrine or phenylephrine, and mephentermine was selected in one study [ 20 ]. Seven studies [ 11 , 12 , 14 , 16 , 17 , 19 , 20 ] used vasopressors when patients developed hypotension, while one study [ 18 ] combined crystalloid boluses and ephedrine.…”

“…Seven studies [ 11 , 12 , 15 – 18 , 21 ] used ephedrine to treat intraoperative hypotension, two studies [ 14 , 19 ] used ephedrine or phenylephrine, and mephentermine was selected in one study [ 20 ]. Seven studies [ 11 , 12 , 14 , 16 , 17 , 19 , 20 ] used vasopressors when patients developed hypotension, while one study [ 18 ] combined crystalloid boluses and ephedrine. Nine studies [ 11 , 12 , 14 – 18 , 20 , 21 ] recorded the number of patients with hypotension throughout the surgery, and one study [ 19 ] recorded hypotension at 3 and 5 min after anesthesia induction.…”

“…Seven studies [ 11 , 12 , 14 , 16 , 17 , 19 , 20 ] used vasopressors when patients developed hypotension, while one study [ 18 ] combined crystalloid boluses and ephedrine. Nine studies [ 11 , 12 , 14 – 18 , 20 , 21 ] recorded the number of patients with hypotension throughout the surgery, and one study [ 19 ] recorded hypotension at 3 and 5 min after anesthesia induction.…”

“…There was no significant difference in umbilical arterial pH between the two groups ( Figure 6(a) ). Seven studies [ 11 , 12 , 15 – 18 , 21 ] analyzed Apgar scores, and none of them reported Apgar scores < 7 at 5 min. Data from 4 studies [ 11 , 15 , 17 , 21 ] showed that the incidence of nausea and vomiting was higher in the preload group (OR = 3.40, 95% CI = 1.88–6.16, and P < 0.0001) ( Figure 6(b) ).…”

Efek Pemberian Cairan Koloid dan Kristaloid terhadap Tekanan Darah

“…Hal ini karena perbandingan harga cairan koloid yang jauh lebih mahal dari pada cairan kristaloid. 13 Penelitian mengenai perbandingan efek pemberian cairan kristaloid atau koloid terhadap tekanan darah telah banyak dilakukan di Indonesia secara preloading ataupun coloading, namun belum pernah dilakukan di Banjarmasin. Rumah Sakit Umum Daerah Ulin Banjarmasin merupakan rumah sakit terbesar yang menerima rujukan daerah, selain itu cairan koloid pada beberapa tempat di daerah masih sulit didapatkan.…”