In this study, we will investigate the effect of left lateral tiling performed after spinal block on maternal hemodynamics compared to ordinary supine position
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
450
the patient will be placed in regular supine position after spinal anesthesia
the patient will be placed in left lateral tilted position after spinal anesthesia
The patient will receive 10 mg Bupivacaine for spinal anesthesia
Cairo University
Cairo, Egypt
RECRUITINGpostspinal hypotension
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
Time frame: 30 minutes after spinal anesthesia
severe postspinal hypotension
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
Time frame: 30 minutes after spinal anesthesia
Post-delivery hypotension
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
Time frame: 10 minutes after delivery
systolic blood pressure
systolic blood pressure measured in mmHg
Time frame: 60 minutes after spinal block
diastolic blood pressure
diastolic blood pressure measured in mmHg
Time frame: 60 minutes after spinal block
heart rate
heart rate measured in beats per minute
Time frame: 60 minutes after spinal block
incidence of nausea and vomiting
number of patients who develop nausea and vomiting divided by the total number of patients in the group
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Time frame: 60 minutes after spinal block
ephedrine consumption
total amount of ephedrine consumed during the operation (measured in milligrams)
Time frame: 60 minutes after spinal block
Atropine consumption
total amount of atropine consumed during the operation (measured in milligrams
Time frame: 60 minutes after spinal block
APGAR score
APGAR score for detection of the well being of the fetus
Time frame: 1 minute after delivery
APGAR score
APGAR score for detection of the well being of the fetus
Time frame: 10 minute after delivery