title: Maternal position during caesarean section for preventing maternal and neonatal complications.
abstract: BACKGROUND
  During caesarean section mothers can be in different positions. Theatre tables could be tilted laterally, upwards, downwards or flexed and wedges or cushions could be used. There is no consensus on the best positioning at present.
  
  
  OBJECTIVE
  We assessed all available data on positioning of the mother to determine if there is an ideal position during caesarean section that would improve outcomes.
  
  
  METHODS
  We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2009), PubMed (1966 to 14 September 2009) and manually searched the references of retrieved articles.
  
  
  METHODS
  Randomised trials of woman undergoing caesarean section comparing different positions.
  
  
  METHODS
  Two authors assessed eligibility, trial quality and extracted data.
  
  
  RESULTS
  We identified 17 studies with a total of 683 woman included. We included nine studies and excluded eight studies. Included trials were of variably quality with small sample sizes. Most comparisons had data from single trials. This is a shortcoming and applicability of results is limited.The incidence of air embolism was not affected by head up versus horizontal position (risk ratio (RR) 0.91; 95% confidence interval (CI) 0.65 to 1.26). We found no change in hypotensive episodes when comparing left lateral tilt (RR 0.11; 95% CI 0.01 to 1.94), right lateral tilt (RR 1.25; 95% CI 0.39 to 3.99) and head down tilt (mean difference (MD) -3.00; 95% CI -8.38 to 2.38) with horizontal positions or full lateral tilt with 15-degree tilt (RR 1.20; 95% CI 0.80 to 1.79). Hypotensive episodes were decreased with manual displacers (RR 0.11; 95% CI 0.03 to 0.45), a right lumbar wedge compared to a right pelvic wedge (RR 1.64; 95% CI 1.07 to 2.53) and increased in right lateral tilt (RR 3.30; 95% CI 1.20 to 9.08) versus left lateral tilt.Position did not affect systolic blood pressure when comparing left lateral tilt (MD 2.70; 95% CI -1.47 to 6.87) or head down tilt (RR 1.07; 95% CI 0.81 to 1.42) to horizontal positions, or full lateral tilt with 15-degree tilt (MD -5.00; 95% CI -11.45 to 1.45). Manual displacers showed decreased fall in mean systolic blood pressure compared to left lateral tilt (MD -8.80; 95% CI -13.08 to -4.52).Position did not affect diastolic blood pressures when comparing left lateral tilt versus horizontal positions. (MD-1.90; 95% CI -5.28 to 1.48). The mean diastolic pressure was lower in head down tilt (MD -7.00; 95% CI -12.05 to -1.95) when compared to horizontal positions.There were no statistically significant changes in maternal pulse rate, five-minute Apgars, maternal blood pH or cord blood pH when comparing different positions.
  
  
  CONCLUSIONS
  There is limited evidence to support or clearly disprove the value of the use of tilting or flexing the table, the use of wedges and cushions or the use of mechanical displacers. Larger studies are needed.
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Stellenbosch University and Tygerberg Hospital, PO Box 19063, Tygerberg, Western Cape, South Africa, 7505.
authors.forename: Catherine
authors.initials: C
authors.lastname: Cluver
authors.forename: Natalia
authors.initials: N
authors.lastname: Novikova
authors.forename: G Justus
authors.initials: GJ
authors.lastname: Hofmeyr
authors.forename: David R
authors.initials: DR
authors.lastname: Hall
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D002585:Cesarean Section / Q000379:methods*; D004618:Embolism, Air / Q000517:prevention & control; D005260:Female; D006801:Humans; D007022:Hypotension / Q000517:prevention & control; D007431:Intraoperative Complications / Q000517:prevention & control; D056888:Patient Positioning / Q000379:methods*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic