Background: Maternal hypotension during spinal anaesthesia for Caesarean delivery is a common event, with potential detrimental consequences. We led a prospective, randomized study to compare the effects of two strategies on neonatal and maternal wellbeing. Methods: Parturients scheduled for elective Caesarean section in spinal anaesthesia were preoperatively studied with a supine stress test. Those with a positive test were enrolled in the study and received a solution of 0.5% hyperbaric bupivacaine 12.5 mg and 0.02% morphine 200 µg intrathecally. Patients received a 37.5 mg/h preventive intravenous (IV) infusion of ephedrine (Pharmacologic Group), or a 15° left lateral tilt (Non-Pharmacologic Group). In Pharmacolgic Group hypotension was treated for 20% drops in systolic blood pressure; in Non-Pharmacolgic Group only severe hypotension – defined as a 40% drop in systolic blood pressure – was treated. Results: Thirty-six patients were studied. Study groups were statistically similar in terms of demographic variables and intraoperative times. No statistical differences were found in terms of umbilical arterial blood base excess [-1.4 (-3.7 to -0.3) mEq/l Pharmacologic Group vs. -1.7 (-2.7 to -1.0) mEq/l Non-Pharmacologic Group; p=0.815] and other umbilical blood gas values. Apgar scores were statistically similar between study groups. Treatment for hypotension was required by 13 (72.2%) patients in Pharmacologic Group and 9 (50%) patients in Non-Pharmacologic Group (p=0.171). No differences were found at the analysis of serial changes in vital signs. Conclusions: Both studied strategies guaranteed a comparable safe outcome in terms of maternal and neonatal wellbeing. (www.actabiomedica.it)
Zasa M, Conci E, Marchignoli A, Pini R, Passeri L, Fanelli G, Cornini A. Comparison of two different approaches to hypotension following spinal anaesthesia for Caesarean delivery: effects on neonatal and maternal wellbeing. Acta Biomed [Internet]. 2015 Apr. 27 [cited 2022 May 21];86(1):45-52. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/4192
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