The recommended position of the mother under caesarean section after spinal anesthesia is 15 degrees left. However, recent research has challenged the basic principles and practicality of the left-turn 15 degree position. Higuchi et al used nuclear magnetic imaging to directly prove that in the supine position, the position of the full-left 30 degrees of the full-term pregnancy of the full-term pregnancy relieved the inferior vena cava compression and the left-angle of 15 degrees did not. Therefore, there are more and more controversies about the choice of cesarean section position. This experiment aims to explore effects of different positions (15 degrees left, 30 degrees left and supine) for elective cesarean section on lumbar anesthesia for fetal acid-base balance and maternal Hemodynamic.
When the pregnant woman in the third trimester is in the supine position, the enlarged uterus may oppress the inferior vena cava, thereby reducing the amount of blood and heart output of the pregnant woman. This affects the mother mainly, such as dizziness, nausea and vomiting, chills, and severe irritability，difficulty breathing or even cardiac arrest, the impact on the fetus is mainly the reduction of blood flow in the placenta, affecting the blood exchange of the uterus placenta, causing neonatal respiratory distress, acidosis and even death. The recommended position of the mother under caesarean section after spinal anesthesia is 15 degrees left. However, recent research has challenged the basic principles and practicality of the left-turn 15 degree position. Higuchi et al used nuclear magnetic imaging to directly prove that in the supine position, the position of the full-left 30 degrees of the full-term pregnancy of the full-term pregnancy relieved the inferior vena cava compression and the left-angle of 15 degrees did not. Therefore, there are more and more controversies about the choice of cesarean section position. This experiment aims to explore effects of different positions (15 degrees left, 30 degrees left and supine) for elective cesarean section on lumbar anesthesia for fetal acid-base balance and maternal Hemodynamic.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
75
After the spinal anesthesia is completed, the wedge sponge is placed between the patient's pelvis and ribs and the wedge is removed before the skin is cut.
Liu Tian yu
Xuzhou, Jiangsu, China
Umbilical artery blood pH
Use a blood gas analyzer to measure
Time frame: Immediately after delivery
Other UA and UV blood gas analysis values（pH, base excess, lactate , Umbilical artery blood PaCO2
Use a blood gas analyzer to measure, PaCO2 in mmHg.
Time frame: Immediately after delivery
Fetal Apgar score (1 minute after birth) And 5 minutes
Measured by Apgar score.The Apgar scoring system is divided into five categories（muscle tone，heart rate，grimace and respiration) Appearance. Each category receives a score of 0 to 2 points. At most, a child will receive an overall score of 10（The higher the score, the better the child's condition）.
Time frame: One minute and five minutes after the baby is delivered
The incidence of nausea in pregnant women
Anesthesiologist observes combined patient dictation.
Time frame: Intraoperative
The incidence of vomiting in pregnant women
Anesthesiologist observes combined patient dictation
Time frame: Intraoperative
The incidence of hypotension in pregnant women
The increase of SBP \<20% baseline SBP or SBP \< 90/60mmHg
Time frame: Intraoperative
The incidence of hypertension in pregnant women
The increase of SBP \>20% baseline SBP
Time frame: Intraoperative
The incidence of bradycardia in pregnant women
Heart rate less than 60 times per minute
Time frame: Intraoperative
One min (T1), 3 min (T2), 5 min (T3), 7 min (T4), 9 min (T5), 11 min (T6), 13 min (T7) and 15 min (T8) blood pressure after subarachnoid injection (completion of the subarachnoid injection was defined as 0 time point)
Measured by a sphygmomanometer.Systolic and diastolic blood pressure will be measured every minute during the study.
Time frame: Intraoperative
One min (T1), 3 min (T2), 5 min (T3), 7 min (T4), 9 min (T5), 11 min (T6), 13 min (T7) and 15 min (T8) heart rate after subarachnoid injection (completion of the subarachnoid injection was defined as 0 time point)
Obtained by ECG measurement
Time frame: Intraoperative
Dosage of phenylephrine during surgery
Used by an anesthesiologist based on the patient's blood pressure and heart rate.If the patient's blood pressure is less than 80% of the baseline level or less than 90/60 mmHg and the heart rate is greater than 60 times per minute, the patient is given 4 ug of phenylephrine.
Time frame: Intraoperative
Dosage of ephedrine during surgery
Used by an anesthesiologist based on the patient's blood pressure and heart rate.If the patient's blood pressure is less than 80% of the baseline level or less than 90/60 mmHg and the heart rate is smaller than 60 times per minute, the patient is given 6 mg of ephedrine.
Time frame: Intraoperative
Dosage of atropine during surgery
Used by an anesthesiologist based on the patient's blood pressure and heart rate.If the patient's heart rate is smaller than 60 times per minute, and blood pressure is more than 80% of the baseline level and more than 90/60 mmHg， the patient is given 0.5 mg of atropine.
Time frame: Intraoperative
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