INTRODUCTION: Enlarged gravid uterus causing aortocaval compression may decrease the venous
return and cause maternal hypotension. Maternal position after neuraxial blockade may exacerbate the
impact of aortocaval compression and consequences on cardiovascular instability. Left uterine displacement (LUD) after
spinal anaesthesia in lower segment cesarean section is essential in preventing supine hypotension syndrome. Decreased
cardiac output secondary to vena cava obstruction by the gravid uterus can be prevented by lateral tilt position.
AIM OF THE STUDY: This study is therefore designed to evaluate the role of leftward uterine displacement by table tilt using
clinometer software or by using crawford wedge tilt and compare the effects on hemodynamics in parturient undergoing lower
segment cesarean section (LSCS) under subarachnoid block
MATERIALS AND METHODS: The study was carried out in the Department of Anaesthesiology involving Department of
Obstetrics and gynecology in Kanyakumari Government Medical College from January 2018 to June 2019. Patients were
allocated into two groups by randomization. After spinal anaesthesia parturient in Group T: Lateral Table Tilt by using
clinometer -15 degree- (40 parturient). Parturient in Group W: Crawford wedge Tilt- (40 parturient). Patients, age, body weight,
BMI and baseline vital parameters were recorded. Incidence of hypotension after spinal anaesthesia in a cesarean section,
Total dose Vasopressor required, Level of blockade, APGAR Score, Surgeon satisfaction grading.
RESULTS: The demographic parameters like age, height, weight, BMI and the indication for surgery were similar in both
groups. There were no difference in mean height level of block between both groups. In comparison of hypotensive incidence in
both groups, the high incidence noted in the GROUP W (wedge group) (35%) is higher than the incidence in GROUP T (table tilt)
nd th th (7.5%). The incidence of hypotension is signicantly noted at 2 , 4 , 5 minute after the subarachnoid block in wedge group
compared to the table tilt group. The dose of vasopressor requirements and average ephedrine dose used is less in GROUP T
(table tilt) (0.6±2.3mg) compared to GROUP W (wedge) (3.9±5.7 mg). In comparison of surgeon satisfaction between both
groups, surgeons are much satised with the wedge group patient and found difcult, disturbing and sometimes unbearable
st th while perform the surgery for the patient in table tilt. The APGAR Scores in GROUP W at 1 minute and 5 minute is (7.3±0.5 and
st th 8.7 ±0.5) respectively which are relatively satisfactory compared to the GROUP T (6.8±0.6 and 8.3±0.6) at 1 and 5 minute.
CONCLUSION: Table tilt provide a good relief from inferior vena cava and aortocaval compression when compared to the
wedge placed under the right hip during cesarean section done under subarachnoid block. Using the wedge is easier and
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surgeons at our institute found it more comfortable than the table tilt to 15 but anesthetists feel better with table tilt because
there is little incidence of hemodynamic variation. We conclude that all the parturient posted for caesarean section should be
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given a table tilt of 15 placed with angle measured exactly by clinometer to decrease incidence of hypotension occurring due to
aortocaval compression
