Cesarean Section Complications
Conditions
Brief summary
In this study, we will investigate the effect of left lateral tiling performed after spinal block on maternal hemodynamics compared to ordinary supine position
Detailed description
Maternal hypotension is a common complication after spinal anesthesia for cesarean delivery (CD). Aortocaval compression is one of the theoretical mechanisms precipitating for post-spinal hypotension (PSH) for CD. Positioning of the patients in the left lateral tilted position after preforming spinal block was frequently considered a standard protocol for minimizing aortocaval compression and improve maternal hemodynamics during CD; however, the latest Cochrane database review reported that there is no adequate evidence to support any positioning protocol for prevention of PSH. Moreover, a recent study was conducted in full term pregnant women reporting no improvement in cardiac output with left lateral tilting. In this study, the effect of left lateral tiling performed after spinal block on maternal hemodynamics will be compared to ordinary supine position.
Interventions
OTHERsupine position
the patient will be placed in regular supine position after spinal anesthesia
OTHERleft lateral tilted position
the patient will be placed in left lateral tilted position after spinal anesthesia
DRUGBupivacaine
The patient will receive 10 mg Bupivacaine for spinal anesthesia
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* full term * singleton pregnant women * scheduled for elective cesarean delivery
Exclusion criteria
* Cardiac morbidities * hypertensive disorders of pregnancy * peripartum bleeding * baseline systolic blood pressure (SBP) \< 100 mmHg * body mass index \> 35
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| postspinal hypotension | 30 minutes after spinal anesthesia | The number of patients who develop hypotension (defined as decreased SBP less than 80% of the baseline reading during the period from intrathecal injection till delivery of the fetus) after spinal block divided by the total number in the group |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Post-delivery hypotension | 10 minutes after delivery | number of patients who develop hypotension (defined as decreased SBP less than 80% of the baseline reading after delivery of the fetus and starting oxytocin infusion |
| systolic blood pressure | 60 minutes after spinal block | systolic blood pressure measured in mmHg |
| diastolic blood pressure | 60 minutes after spinal block | diastolic blood pressure measured in mmHg |
| heart rate | 60 minutes after spinal block | heart rate measured in beats per minute |
| severe postspinal hypotension | 30 minutes after spinal anesthesia | The number of patients who develop hypotension (defined as decreased SBP less than 60% of the baseline reading during the period from intrathecal injection till delivery of the fetus) after spinal block divided by the total number in the group |
| ephedrine consumption | 60 minutes after spinal block | total amount of ephedrine consumed during the operation (measured in milligrams) |
| Atropine consumption | 60 minutes after spinal block | total amount of atropine consumed during the operation (measured in milligrams |
| APGAR score | 1 minute after delivery | APGAR score for detection of the well being of the fetus |
| incidence of nausea and vomiting | 60 minutes after spinal block | number of patients who develop nausea and vomiting divided by the total number of patients in the group |
Countries
Egypt
Contacts
Primary ContactAhmed Shash, Professor
Outcome results
None listed