title: Update on volume therapy in obstetrics.
abstract: Symptomatic hypotension (maternal nausea, vomiting, dizziness and dyspnoea) during spinal anaesthesia for caesarean delivery remains a prevalent clinical problem. Severe and sustained hypotension can lead to impairment of uteroplacental perfusion, foetal hypoxia, acidosis, neonatal depression and further adverse maternal outcomes of unconsciousness, pulmonary aspiration, apnoea and cardiac arrest. Mechanical methods aimed at countering the effects of aortocaval compression do not reliably prevent maternal hypotension. Intravenous crystalloid preloading (given prior to administration of spinal anaesthesia) has poor efficacy, and focus has changed towards decreased use of crystalloid preload and ephedrine, to increased use of coload (given at the time of spinal administration) with colloids or crystalloids, and early use of phenylephrine. The recent multicentre, randomised, double-blinded CAESAR trial demonstrated the efficacy of a mixed 500 ml 6% hydroxyethyl starch (HES) 130/0.4 + 500 ml Ringer's lactate (RL) preload in significantly reducing hypotension, compared to a 1-l RL preload, without adverse effects on coagulation and neonatal outcomes in healthy parturients undergoing caesarean delivery under spinal anaesthesia.
authors.affiliation: Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore; Duke University - NUS Graduate Medical School, Singapore. Electronic address: teohwendy@yahoo.com.
authors.forename: Wendy H L
authors.initials: WH
authors.lastname: Teoh
authors.affiliation: Department of Anaesthesiology, Pain Medicine and Intensive Care, University Hospital of Muenster, Muenster, Germany; Fresenius Kabi AG, Bad Homburg, Germany. Electronic address: martin.westphal@gmx.net.
authors.forename: Martin
authors.initials: M
authors.lastname: Westphal
authors.affiliation: Department of Anaesthesiology, Pain Medicine and Intensive Care, University Hospital of Muenster, Muenster, Germany. Electronic address: tim.kampmeier@gmail.com.
authors.forename: Tim G
authors.initials: TG
authors.lastname: Kampmeier
mesh_terms: D003102:Colloids / Q000008:administration & dosage; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000379:methods / Q000639:trends*; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage; D009774:Obstetrics / Q000379:methods / Q000639:trends*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic / Q000639:trends
chemical_list: D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions
keywords: HES; caesarean delivery; colloids; coload; crystalloids; hypotension; obstetrics; preload; spinal anaesthesia; volume