Comparison of Hypotension During Spinal Anaesthesia for C-section


Maternal hypotension during C section has been reported due to aortocaval compression (ACC) by full term uterus in supine position. This study aimed at reporting the effect of left tilt on maternal hemodynamics.

Full Title of Study: “To Tilt or Not to Tilt?: Comparison of Severity of Hypotension Between Supine and Left Tilt Position During Spinal Anesthesia for Elective C-section”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Retrospective
  • Study Primary Completion Date: February 1, 2022

Detailed Description

C-section is usually done in either general anesthesia or regional (epidural or spinal) anesthesia. The choice lies with the mother. In spinal anesthesia the anaesthetic agent is injected into the subarachnoid space. Hypotension in supine position that is associated with full term gravid uterus has been explained by compression of inferior venacava (IVF) and aorta. This aortocaval compression (ACC) can also cause hypotension during C- section after spinal block. The aim of our study was to study the effect of left tilt on systolic (SBP) and diastolic blood pressure (DBP), heart rate and the frequency of phenylephrine used to maintain the blood pressure in normal range.

Arms, Groups and Cohorts

  • Supine group
    • Spinal anaesthesia was administered in sitting position and then supine position was maintained.
  • Left tilt group
    • Spinal anesthesia was administered in sitting position was then maintained on supine position until full anesthetic effect (motor and sensory loss) and then table was tilted 15 degrees to the left.

Clinical Trial Outcome Measures

Primary Measures

  • Group 1 – Supine Group
    • Time Frame: December 2021 to February 2022
    • Systolic blood pressures decreased significantly in the supine group
  • Group 2 – Left tilt Group
    • Time Frame: December 2021 to February 2022
    • The decrease in the diastolic blood pressure was marginally significant in the left tilt group.

Participating in This Clinical Trial

Inclusion Criteria

  • Participants ≥ 18 years, undergoing Elective Caesarean Section for term singleton pregnancy, ASA I/II, were included after their consent for the participation of the study. Exclusion Criteria:

  • Participants with co-morbidities (Hypertension, diabetes mellitus, cardiovascular or cerebrovascular disease and a history of coagulation disorders), any contraindication to spinal anesthesia, with multiple pregnancy, pre-eclampsia, obesity (body mass index > 30 kg.m2), intrauterine growth were excluded from the study.

Gender Eligibility: Female

Only females included undergoing C-section

Minimum Age: N/A

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Rawalpindi Medical College
  • Provider of Information About this Clinical Study
    • Principal Investigator: Rubaid Azhar Dhillon, MBBS – Rawalpindi Medical College

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