title: Comparison of two different approaches to hypotension following spinal anaesthesia for Caesarean delivery: effects on neonatal and maternal wellbeing.
abstract: BACKGROUND
  Maternal hypotension during spinal anaesthesia for Caesarean delivery is a common event, with potential detrimental consequences. We led a prospective, randomized study to compare the effects of two strategies on neonatal and maternal wellbeing.
  
  
  METHODS
  Parturients scheduled for elective Caesarean section in spinal anaesthesia were preoperatively studied with a supine stress test. Those with a positive test were enrolled in the study and received a solution of 0.5% hyperbaric bupivacaine 12.5 mg and 0.02% morphine 200 µg intrathecally. Patients received a 37.5 mg/h preventive intravenous (IV) infusion of ephedrine (Pharmacologic Group), or a 15° left lateral tilt (Non-Pharmacologic Group). In Pharmacolgic Group hypotension was treated for 20% drops in systolic blood pressure; in Non-Pharmacolgic Group only severe hypotension - defined as a 40% drop in systolic blood pressure - was treated.
  
  
  RESULTS
  Thirty-six patients were studied. Study groups were statistically similar in terms of demographic variables and intraoperative times. No statistical differences were found in terms of umbilical arterial blood base excess [-1.4 (-3.7 to -0.3) mEq/l Pharmacologic Group vs. -1.7 (-2.7 to -1.0) mEq/l Non-Pharmacologic Group; p=0.815] and other umbilical blood gas values. Apgar scores were statistically similar between study groups. Treatment for hypotension was required by 13 (72.2%) patients in Pharmacologic Group and 9 (50%) patients in Non-Pharmacologic Group (p=0.171). No differences were found at the analysis of serial changes in vital signs.
  
  
  CONCLUSIONS
  Both studied strategies guaranteed a comparable safe outcome in terms of maternal and neonatal wellbeing. (www.actabiomedica.it).
authors.affiliation: . michele.zasa@gmail.com.
authors.forename: Michele
authors.initials: M
authors.lastname: Zasa
authors.forename: Eleonora
authors.initials: E
authors.lastname: Conci
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marchignoli
authors.forename: Rita
authors.initials: R
authors.lastname: Pini
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Passeri
authors.forename: Guido
authors.initials: G
authors.lastname: Fanelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Cornini
mesh_terms: D000328:Adult; D000775:Anesthesia, Spinal; D002585:Cesarean Section; D004809:Ephedrine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D007231:Infant, Newborn; D007744:Obstetric Labor Complications / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D056888:Patient Positioning; D011247:Pregnancy; D011446:Prospective Studies; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D004809:Ephedrine