Pharmacological or Non-Pharmacological Management of Maternal Hypotension During Elective Cesarean Section Under Subarachnoid Anesthesia: a Randomized, Controlled Trial
Description:
The supine hypotensive syndrome of pregnancy is induced by compression of the inferior caval
vein by the enlarged uterus. It occurs in approximately 8% of pregnant women at term. More
patients may develop an asymptomatic variety of this syndrome in the supine position. The
hypotensive effect of spinal anesthesia per se may thus be aggravated in a significant number
of term parturients. A preoperative supine stress test (SST) before elective cesarean section
under spinal anesthesia has been shown to predict severe systolic hypotension with reasonable
accuracy.
Different strategies have been proposed for the management of this complication; they can be
divided into pharmacological and non-pharmacological ones.
According to pharmacological strategies, vasoactive drugs are used to treat hypotension
induced by sympathetic efferent blockade following spinal anesthesia. To this end, α-agonist
ephedrine is commonly considered the best choice because of its minimal impact on the
fetoplacental circulation. However, excessive use of ephedrine may be detrimental to neonatal
well-being because of its vasoconstrictor effect on fetoplacental circulation.
Non-pharmacological treatments may represent a valuable, safer alternative. According to many
authors non-pharmacological treatments aimed at removing the cause of aorta-caval compression
syndrome are to be preferred because more appropriate from an etiopathogenetic point of view.
The use of a wedge-shaped cushion placed under the right hip is a well-known
non-pharmacological strategy which allows the uterine left lateral displacement and,
consequently, the removing of the compression from the inferior vena cava.
The aim of the present study is to compare, through the evaluation of neonatal well-being,
the efficacy of these approaches to hypotension after spinal anesthesia for elective
Caesarean section in parturients affected by aorto-caval compression.
Condition:
Pregnancy
Treatment:
Bupivacaine
Start Date:
September 2009
Sponsor:
University of Parma
For More Information:
https://clinicaltrials.gov/show/NCT00991627