Tilt Caesarean Section

Ansari, Ishtyaque; Wallace, G. B.; Clemetson, C. Alan B.; Mallikarjuneswara, V. R.; Clemetson, C. D. M.

doi:10.1111/j.1471-0528.1970.tb03597.x

Cited by 32 publications

(11 citation statements)

References 10 publications

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“…On the other hand Bromage (1975) stated that during the second stage of labour foetal pH fell by 0•26 over 30 minutes in the dorsal position but not in the lateral position. Ansari et al (1970) reported a significant improvement in umbilical vessel oxygen saturation at Caesarian Section when a ten degree left tilt was instituted, especially in patients under spinal block. Ueland et al (1968) found a 34% fall in cardiac output after subarachnoid block in the supine position prior to Caesarian Section.…”

Section: Stagnant Hypoxiamentioning

confidence: 95%

Foetal Hypoxia—An Anaesthetist's approach to Classification and Prevention

Brownridge¹

1978

Anaesth Intensive Care

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Nearly one third of perinatal deaths are due to hypoxia occurring during pregnancy and labour. M any factors contribute to foetal hypoxia and in order to group these into orderly categories a classification of hypoxia, which is familiar to anaesthetists, has been applied to the maternal and foetal circulations. This theoretical approach forms a logical guide to our understanding the cause, prevention and treatment of foetal hypoxia.

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Section: Stagnant Hypoxiamentioning

confidence: 95%

Foetal Hypoxia—An Anaesthetist's approach to Classification and Prevention

Brownridge¹

1978

Anaesth Intensive Care

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“…In this respect, our results confirm the findings of Ansari et a1. 28 and CrawfordZ4 who used the lateral tilt during general anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

Epidural analgesia with left lateral tilt for Caesarean section

Baheti

Pandit

Devi³

et al. 1975

Anaesthesia

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The specific anaesthetic dangers to the mother during anaesthesia for Caesarean section include the aspiration of highly acidic stomach contents, l s Z and supine hypotensive synd r~m e .~.~ The main dangers to the baby are respiratory depression due to the transfer of anaesthetic and narcotic drugs and asphyxia due to maternal hypoxia and hypotension. No uniform pattern has yet emerged regarding the choice of anaesthesia for Caesarean section.Light general anaesthesia with thiopentone, nitrous-oxide, oxygen and muscle relaxants has the advantage of providing a stable cardiovascular system and a better control of oxyg e n a t i~n ,~ but the danger of aspiration to the mother still All general anaesthetics cross the placental barrier producing some degree of foetal depression. The incidence of unpleasant recall during this operation under light general anaesthesia is another drawback.There is less risk of aspiration of stomach contents or of metabolic disturbances with spinal or epidural analgesia than with any type of general anaesthetic technique, but the supine hypotensive syndrome may be exaggerated.The high incidence of hypotension has made these techniques unpopular with many anaesthetists.Post-spinal h e a d a~h e '~ may occur following thecal puncture but permanent neurological complications are now recognised to be very rare.15-17A number of studies have been carried out to evaluate means of preventing the so-called 'inevitable' hypotension during spinal and epidural analgesia. The suggested prophylactic measures include the use of small doses of local analgesic drugs, l 8 prevention of bradycardia by means of intravenous atropine, l 9 infusion of relatively large volumes of intravenous fluids,20 and the use of head down posture to improve venous return and cardiac output.12 Methods to release the pressure from gravid uterus on the inferior vena cava, iliac veins, and lower part of abdominal aorta include lateral uterine displacement (LUD) either manually or mechanically21*22 and the use of v a s o p r e s~o r s .~~ It was decided to keep these factors in mind in a study of a series of patients undergoing Caesarean section in whom a standard method of epidural analgesia was employed, using left lateral tilt in an effort to reduce the incidence of hypotension. Materials and methodsThe study was carried out in seventy-five healthy women scheduled for either elective or emergency Caesarean section. Patients with severe cardiovascular disease, hypovolaemia, local sepsis, cord prolapse or active bleeding were excluded from the study.All patients were prernedicated with intravenous atropine 0.6 mg just prior to the block. Epidural block was performed by a standard method using a Tuohyneedle in L2/3 interspace and the loss of resistance sign. Lignocaine 2% with 1 :200,000 adrenaline was used in all cases. The dose schedule is shown in Table 1.Various steps were taken to prevent hypotension and hypoxia. These were: atropine 0.6 mg i.v. just prior to the block; preloading of circulation with 0.9% saline 500-1000 ...

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“…The supine position has also been considered harmful to the fetus, especially during extradural block (Crawford, Burton and Davies, 1972). 0007-0912/79/080767-07 $01.00 anaesthesia (Ansari et al, 1970;Crawford, Burton and Davies, 1972;Downing et al, 1974), but there is still little direct evidence of a harmful effect of the maternal supine position on the fetus during extradural block for vaginal delivery.…”

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confidence: 99%

Effect of Maternal Positing on Fetal Heart Rate During Extradural Analgesia

Huovinen

Teramo

1979

British Journal of Anaesthesia

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Using continuous cardiotocography, the effect of maternal position on fetal heart rate (FHR) was studied during extradural analgesia (EA) with either 50 or 100 mg of etidocaine without adrenaline for labour and vaginal delivery. Of 70 healthy parturients, 39 were supine and 40 were in the lateral position. FHR was normal in all patients during the control period before EA, and remained normal during EA in 53. Transient abnormal patterns occurred in 26 patients, 22 (56%) in the supine group and four (10%) in the lateral group, a significant difference (P less than 0.001). The decrease in arterial pressure (AP) did not differ between the groups, but the frequency of abnormal FHR associated with a small or moderate decrease in AP (30% or less) was greater in the supine (51%) than in the lateral group (3%).

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Tilt Caesarean Section

Cited by 32 publications

References 10 publications

Foetal Hypoxia—An Anaesthetist's approach to Classification and Prevention

Foetal Hypoxia—An Anaesthetist's approach to Classification and Prevention

Epidural analgesia with left lateral tilt for Caesarean section

Effect of Maternal Positing on Fetal Heart Rate During Extradural Analgesia

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