Time and Lateral Tilt at Caesarean Section

Crawford, J. Selwyn; Burton, Marilyn; Davies, Paul

doi:10.1097/00132586-197306000-00040

Cited by 19 publications

(7 citation statements)

References 10 publications

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“…The adverse effect of neglecting left uterine displacement at Caesarean section on fetal pH [60, 61] and oxygenation [62] was documented long ago, so much so that left uterine displacement has become a routine part of maternal care at Caesarean section. The great majority of authors of studies cited here from English‐speaking countries used it (Table 4) and where details are incomplete, it can probably be assumed that left uterine displacement was either used in all treatment groups or in none, in any single study.…”

Section: Maternal Posturementioning

confidence: 99%

Anaesthesia for Caesarean section and neonatal acid‐base status: a meta‐analysis*

2005

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SummarySpinal anaesthesia is generally preferred for Caesarean section. Its superiority for the baby is often assumed. Umbilical artery acid-base status provides a valid index of fetal welfare. Twenty-seven studies reporting neonatal acid-base data with different types of anaesthesia were used to compare umbilical artery or vein pH and base deficit, using random-effect meta-analysis. Cord pH was significantly lower with spinal than with both general (difference: )0.015; 95% CI )0.029 to )0.001; 13 studies, 1272 subjects) and epidural anaesthesia (difference )0.013; 95% CI )0.024 to )0.002; 11 studies, 828 subjects). Larger doses of ephedrine contributed to the latter effect (p = 0.023). Sixteen studies reported a base deficit, which was significantly higher for spinal than for general (difference 1.109; 95% CI 0.434-1.784 mEq.l )1 ; seven studies, 695 subject) and epidural anaesthesia (difference 0.910; 95% CI 0.222-1.598 mEq.l ; seven studies, 497 subjects). Spinal anaesthesia cannot be considered safer than epidural or general anaesthesia for the fetus. In labour, regional analgesia has a more favourable effect on the newborn than systemic analgesia [1][2][3], a fact that tends to be neglected by consumers and carers alike. By contrast, it is widely accepted that regional anaesthesia for Caesarean section is preferable to general anaesthesia. Spinal anaesthesia is commonly considered both more practical and safer than other techniques for the mother, and is therefore widely used [4]. It is often assumed, similarly, that spinal anaesthesia for Caesarean section must be better for the baby than general or epidural anaesthesia. There are several reasons for this assumption.• General anaesthesia was shown in the 1970s to depress the Apgar score, although this is reversible and rarely significant by 5 min [5,6].• Maternal hypotension, which is believed to be detrimental to fetal wellbeing, can be minimised by appropriate vasopressor control. Cardiac output, however, is more likely to be impaired by spinal than by epidural anaesthesia [7], is rarely measured and may not be so easily corrected.• The doses of drugs required to induce spinal anaesthesia are small and are therefore unlikely to produce systemic effects in the baby. With the brief duration of anaesthesia before delivery of the baby, however, pharmacological fetal depression is likely to be less important than that following prolonged maternal administration of depressant drugs, as may occur during labour. It must be borne in mind, moreover, that drugs may affect the baby in two ways: firstly via a direct effect, resulting from placental drug transfer, which is transient even when general anaesthesia is used for Caesarean section, and clearly unimportant with spinal anaesthesia; and secondly, through an indirect effect resulting from maternal physiological or biochemical changes, which Anaesthesia, 2005, 60 , pages 636-653 .........................................................................................................................................

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Section: Maternal Posturementioning

confidence: 99%

Anaesthesia for Caesarean section and neonatal acid‐base status: a meta‐analysis*

2005

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“…The common recommendation is a 15°lateral tilt which was ®rst described by Crawford and colleagues in 1972, 2 and was achieved using a wedge. They demonstrated a signi®cant improvement in fetal well-being when mothers were tilted rather than kept supine.…”

mentioning

confidence: 99%

Comparison of measured and estimated angles of table tilt at Caesarean section

Jones

2003

British Journal of Anaesthesia

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“…Using 12 cm wedge under the right hip or buttock, left lateral tilt can give to mother up to 15 0 . Crawford et al [19] used 15 0 tilt for positioning of pregnant women. Caval and aortic compression still evidenced in many studies whatever the degree of tilt is, even at 34 0 [20].…”

Section: Discussionmentioning

confidence: 99%

Comparative study of manual uterine displacement and wedge under right hip in prevention of supine hypotension syndrome in caesarean section under spinal anesthesia

Gonuguntla

Jampala

2016

Int J Med Res Rev

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Introduction: Supine hypotension syndrome results in signs of shock, by decrease in maternal blood pressure. This may result in life threatening complications in mother and fetus. To reduce the incidence of supine hypotension syndrome, few practices were recommended by authors in maternal positioning during C-section. Here in this study we are comparing hemodynamic stability between manual uterine displacement and wedge under right hip. Materials and Methods: 30 parturients were studied by left ward Manual Uterine Displacement (MUD), assigned as Group MUD. Another 30 parturients were studied by placing a 12 cm wedge under right hip (which gives 15 0 left lateral tilt), assigned as Group Wedge. Hemodynamic stability was assessed in between MUD and Wedge groups. Results: Systolic blood pressure was lower with wedge under right buttock or hip than Manual Uterine Displacement and it is statistically insignificant. Diastolic Blood pressure fall was almost similar in both the groups. There is a gradual fall in Mean Arterial Pressure in both groups, which is not significant. Heart rate was lower in Wedge Group when compared to MUD group but it was statistically insignificant. Conclusion: There is no much difference in Hemodynamic changes either by Manual uterine displacement or Wedge under right hip. Surgeons and patients feel more comfortable with Manual uterine displacement than Wedge under right hip, but anesthetists feel better with wedge because there is no need to hold the uterus continuously till delivery of the baby, so anesthesiologist can engage in patient monitoring and treatment.

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Time and Lateral Tilt at Caesarean Section

Cited by 19 publications

References 10 publications

Anaesthesia for Caesarean section and neonatal acid‐base status: a meta‐analysis*

Anaesthesia for Caesarean section and neonatal acid‐base status: a meta‐analysis*

Comparison of measured and estimated angles of table tilt at Caesarean section

Comparative study of manual uterine displacement and wedge under right hip in prevention of supine hypotension syndrome in caesarean section under spinal anesthesia

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