title: A retrospective study to correlate breech presentation and enhanced risk of postspinal hypotension during cesarean delivery.
abstract: BACKGROUND
  Subarachnoid blockade for cesarean section still poses a threat of profound hypotension and can result in unstable maternal and fetal hemodynamics. The correlation of fetal breech and vertex presentation with the occurrence of hypotension under spinal anesthesia is reviewed in this retrospective, double-blind study.
  
  
  METHODS
  The study was conducted on pregnant females scheduled for a lower segment cesarean section between January 2014 and December 2014. After applying inclusion criteria, 568 patients were recruited in the study out of which 363 had vertex and 184 patients had breech presentation. They were divided into two groups, Group I and Group II. The monitoring and therapeutic data (blood pressure, heart rate, arterial oxygen saturation, and dose of vasopressor/atropine) recovered from automated data analysis were analyzed retrospectively for prevalence of hypotension, bradycardia, and hypotension with bradycardia and nausea ± vomiting.
  
  
  RESULTS
  Among Group I, prevalence of hypotension, bradycardia, and hypotension together with bradycardia was 152 (41.83%) patients, eight (2.20%) patients, and seven (1.92%) patients, respectively. In Group II, the prevalence of hypotension, bradycardia, and hypotension with bradycardia was 93 (50.5%) patients, five (2.71%) patients, and six (3.2%) patients, respectively. The difference between the two groups was statistically significant for hypotension. For Group I, 152 patients (41.87%) experienced one, 23 patients (6.33%) experienced two, and three patients (0.82%) experienced three episodes of hypotension. In Group II, 93 (50.5%), 19 (7.89%), and two (1.08%) patients experienced such episodes. The difference was significant with respect of one and two episodes. The prevalence of intraoperative nausea was 11.01% (40 patients) in Group I, whereas 11.41% (21 patients) in Group II. Intraoperative vomiting occurred in 19 patients (5.23%) of Group I and 14 patients (7.60%) of Group II. The height of the block was comparable in both the groups for T6, and the difference was significant in respect to T4 level.
  
  
  CONCLUSIONS
  Incidence of hypotension is more in pregnant females with breech fetal presentation.
authors.affiliation: Department of Anaesthesiology, Maharani Laxmi Bai Medical College, Jhansi, India.
authors.forename: Anshul
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Anaesthesiology, Maharani Laxmi Bai Medical College, Jhansi, India.
authors.forename: Shivali
authors.initials: S
authors.lastname: Pandey
authors.affiliation: Department of Anaesthesiology, Maharani Laxmi Bai Medical College, Jhansi, India.
authors.forename: Roopesh
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Department of Anaesthesiology, Maharani Laxmi Bai Medical College, Jhansi, India.
authors.forename: Chavi
authors.initials: C
authors.lastname: Sethi
authors.affiliation: Department of Gynecology and Obstetrics, Maharani Laxmi Bai Medical College, Jhansi, India.
authors.forename: Sanjya
authors.initials: S
authors.lastname: Sharma
keywords: breech; cesarean section; hypotension; spinal anesthesia