Cesarean Section
Conditions
Keywords
Maternal Position, Tilt, Left Uterine Displacement, Cesarean Delivery, Cesarean Section
Brief summary
During Cesarean Delivery pregnant women are frequently tilted to the left 15 degress to reduce compression of the major blood vessels by the uterus. Despite this common practice, there is no conclusive evidence to support this practice. In fact it may even be deleterious to have women positioned in this position. The aim of the study is to determine whether or not tilting women to the left during cesarean section (CS) is helpful or detrimental. The authors hypothesize that left uterine displacement of 15 degrees, which is commonly employed, is useless for preventing compression of these blood vessels. To investigate this question, women will be randomly assigned to either be tilted 15 degrees to the left during CS or positioned flat on the table. Fetal acid base status, vasopressor/phenylephrine use, patient satisfaction, maternal complications, and fetal complications will all be collected and compared.
Interventions
PROCEDURESupine
Placed in Supine position
PROCEDURELeft uterine displacement
Placed in 15 degrees left uterine displacement
Sponsors
Hartford Hospital
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* term pregnant women with an uncomplicated pregnancy course undergoing scheduled cesarean delivery * ≥18 years old * ASA 1 and 2 (i.e., patient is completely healthy (1) or has mild systemic disease (2) * Able and willing to consent to participate
Exclusion criteria
* Males * \<18 years old * maternal cardiac/pulmonary/hematologic disorders/renal failure * drug/alcohol/tobacco use during pregnancy * essential or pregnancy-induced hypertension * diabetes greater than 10 years * pre-eclampsia or abruptio placenta * \<37 weeks gestation * hemoglobin \< 7 g/dL * intrauterine growth retardation * fetal distress or fetal anomaly * Transverse lie * Ruptured membranes * Severe polyhydramnios or oligohydramnios * Multiple gestation * severe scoliosis or kyphosis, * uterine abnormalities (e.g., large fibroids, bicornuate uterus) * Failed spinal (sensory level \< T6 after 15 minutes) * need to convert to general anesthesia before delivery
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| neonatal base deficit from uterine artery immediately after cesarean delivery of the fetus | One data point will be used. The neonatal gas from the uterine artery immediately after delivery |
Secondary
| Measure | Time frame |
|---|---|
| total phenylephrine use in micrograms prior to delivery | The aggregate of the phenylephrine used immediately after spinal (total of 20 minutes) or until delivery of the baby |
| APGAR scores of the newborn as assessed by the neonatologist immediately after cesarean delivery | 1 and 5 minute apgar scores of the newborn fetus will be compared |
Countries
United States
Contacts
Primary Contactadam sachs, MD
Outcome results
None listed