Anesth Pain Med.  2019 Jul;14(3):266-271. 10.17085/apm.2019.14.3.266.

Effects of fetal position on maternal hemodynamics after spinal anesthesia for cesarean delivery

• Park YW
• Lee IH

• KMID: 2454810
• DOI: http://doi.org/10.17085/apm.2019.14.3.266

Abstract

BACKGROUND
Aortocaval compression by the gravid uterus is a known physiological phenomenon that is classically claimed to cause supine hypotension in full-term pregnant women. This study aimed to investigate the effects of fetal position on maternal hemodynamics after spinal anesthesia during cesarean delivery.
METHODS
In total, 71 women with intrauterine pregnancy over 36 weeks of gestation who were scheduled for elective cesarean delivery under spinal anesthesia were enrolled in the study. Based on the fetal position, the women were divided into two groups: right position group (group R) and left position group (group L). Occurrence of hypotension, requirement for rescue bolus injections of phenylephrine, and the total amount of infused phenylephrine before delivery were recorded in each group.
RESULTS
There was no statistically significant difference in the occurrence of hypotension between the two groups (P = 0.075); however, the amount of phenylephrine required before delivery was significantly greater in group R (P = 0.028). There was a statistically significant decrease in the systolic blood pressure compared with the baseline values in group R, and this change persisted until 15 min after spinal anesthesia.
CONCLUSIONS
There was no difference according to fetal position in the number of patients who showed hypotension before delivery after spinal anesthesia.

Keyword

Cesarean section; Hypotension; Spinal anesthesia

MeSH Terms

Anesthesia, Spinal*
Blood Pressure
Cesarean Section
Female
Hemodynamics*
Humans
Hypotension
Phenylephrine
Physiological Phenomena
Pregnancy
Pregnant Women
Uterus
Phenylephrine

Figure

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  Fig. 1 Consolidated Standards of Reporting Trials flow diagram.

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  Fig. 2 Systolic blood pressure changes for 15 min after induction of spinal anesthesia. SBP: systolic blood pressure, Group L: left fetal position group, Group R: right fetal position group. *P < 0.05 compared with the baseline value in group L. †P < 0.05 compared with the baseline value in group R.

• 

  Fig. 3 Heart rate changes for 15 min after induction of spinal anesthesia. HR: heart rate, Group L: left fetal position group, Group R: right fetal position group. The boxes represent the median (black middle line) limited by the 25th (1Q) and 75th (3Q) percentiles. *P < 0.05 compared with the baseline value in group L. †P < 0.05 compared with the baseline value in group R.

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