Spinal hypotension in obstetrics: Context-sensitive prevention and management. Issue 1 (May 2022)

• Record Type: Journal Article
• Authors: van Dyk, Dominique; Dyer, Robert A.; Bishop, David G.
• Is Part Of: Best practice & research. Volume 36:Issue 1(2022)
• Page Start: 69
• Page End: 82
• Publication Date: 2022-05
• Subjects: hypotension -- spinal anaesthesia -- caesarean section -- vasopressors -- prophylaxis -- resource-limited settings; Anesthesiology -- Periodicals; Anesthesia -- Periodicals; Anesthesia -- Periodicals; Anesthetics -- Periodicals; Anesthesia; Anesthesiology; Periodicals; 617.9605
• DOI: 10.1016/j.bpa.2022.04.001
• Languages: English
• ISSNs: 1521-6869

Abstract

Abstract : Spinal hypotension during caesarean section remains a common complication, with important attendant maternal and fetal adverse outcomes. Research elucidating the mechanisms of spinal hypotension has led to the development and refinement of effective management strategies, with a particular emphasis on prophylactic vasopressor administration. This has proved effective in well-resourced settings, with maternal comfort and the elimination of nausea now considered the primary aim of treatment. In resource-limited settings, sophisticated strategies are not feasible due to insufficient equipment, staff, and expertise. Therefore, in these areas spinal hypotension remains an important cause of maternal and fetal morbidity and mortality. Translational, context-sensitive research in resource-limited settings has shown promise in implementing pragmatic strategies based on research from resource-rich environments. We review the current best practice for the prevention and treatment of spinal hypotension, with a special emphasis on effective strategies in resource-limited settings. We further suggest a research agenda to address the knowledge gap in specific contexts. Highlights: Arteriolar vasodilatation is the principal cause of obstetric spinal hypotension. Vasopressors remain the cornerstone of prophylaxis and treatment in all settings. Management strategies must be context sensitive. There has been minimal research to inform best practice in resource-limited settings.