Techniques for preventing hypotension during spinal anaesthesia for caesarean section

Effects of sitting up for five minutes versus immediately lying down after spinal anesthesia for Cesarean delivery on fluid and ephedrine requirement; a randomized trial

“…This is supported by the results of a systematic review that showed ephedrine and phenylephrine to be equally effective in treating hypotension following spinal anesthesia for Cesarean delivery. 22 Similar results have also been reported by a subsequent meta-analysis 6 and a randomized controlled trial. 5 Prophylactic ephedrine administration, however, has been used to decrease the incidence of maternal hypotension, but a dose of 12 mg is required, and it does not completely eliminate the occurrence of hypotension.…”

“…6 The current study showed that sitting the patient up for five minutes rather than having the patient lie down immediately after spinal anesthesia for Cesarean delivery was associated with a decrease in the amount of fluid administered intraoperatively and in the total dose of ephedrine used after block administration. However, there were no differences between study groups with regard to SBP or heart rate changes over time during the study period.…”

“…23 In addition, compared with placebo, maternal nausea and vomiting and neonatal acidemia are not different when such a dose is administered. 23 On the other hand, high-dose ephedrine has been associated with maternal hypertension and tachycardia 6 and with lower umbilical cord blood pH without increasing the incidence of true fetal acidosis. 22 The increased occurrence of nausea and vomiting and dyspnea among Group L patients could be explained by the higher level of maximum sensory block achieved in this group.…”

“…Several strategies, including uterine displacement, 2 lower legs compression, 3 and the administration of fluids 4 and vasopressors, 5 have been shown to decrease the occurrence of this hypotension; however, none has been shown to eliminate the need to treat it. 6 In contrast, patient position has had variable effects on the incidence of hypotension after spinal anesthesia. [7][8][9][10] In addition, in trials evaluating the effects of patient position on blood pressure changes, there have been studies of the administration of spinal anesthetic in the sitting position (followed immediately by placing the patient in the supine or lateral position) 11 or in the lateral position (followed by either turning the patient supine or keeping the patient in the lateral position).…”

Maternal positions and mobility during first stage labour

“…The weight of the pregnant uterus can compress the abdominal blood vessels, compromising the mother's circulatory function including uterine blood flow (Abitbol 1985;Huovinen 1979;Marx 1982;Ueland 1969), and this may negatively affect the blood flow to the placenta (Cyna 2006;Roberts 1989;Rooks 1999;Walsh 2000). The effects of a woman's position on the frequency and intensity of contractions have also been examined Lupe 1986;Roberts 1983;Roberts 1984;Ueland 1969).…”