International journal of obstetric anesthesia · 2025
Cardiac ultrasound-guided crystalloid preloading before spinal anesthesia vs. standard coloading for scheduled cesarean delivery: a randomized controlled trial.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Ben Marzouk S, Fouzai B, Dhraief N, Ben Amor F, Hkiri T, Hamdi H, Trablesi S, Kalai A, Maghrebi H
Аннотация
BACKGROUNDS: Spinal anesthesia for cesarean delivery commonly causes maternal hypotension (60-80%), leading to adverse maternal and fetal outcomes. Standard crystalloid coloading is preferred over preloading, but individualized fluid strategies based on preload dependence remain untested.
METHODS: In this randomized controlled trial (NCT07108881) conducted at the Tunis Maternity Center, 96 ASA II women with singleton pregnancies scheduled for elective cesarean under spinal anesthesia and preload dependent (ΔLVOT VTI ≥ 12% after passive leg raising via cardiac ultrasound) were enrolled (n=96) and randomized to one of two groups. The active group (A, n=48) received titrated crystalloid preloading (250 mL increments guided by serial LVOT VTI until < 12%) plus standard coloading (10 mL/kg) and the control group (C, n=48) received coloading alone. The primary outcome was the hypotension incidence (SBP decrease > 20% baseline). Secondary outcomes were hypotension duration, rescue fluids, ephedrine use, nausea/vomiting, Apgar scores, and umbilical pH.
RESULTS: Groups were comparable at baseline. Hypotension incidence was lower in group A vs C (37.5% vs. 62.5%; P < 0.001; RR = 0.6, 95% CI 0.39-0.91). Hypotension duration was shorter (2.9 ± 1.4 vs. 5.2 ± 1.6 min; P = 0.012), lowest SBP higher (88 ± 7 vs. 82 ± 9 mmHg; P < 0.001), rescue crystalloids reduced (365 ± 130 vs. 482 ± 116 mL; P = 0.04), and nausea/vomiting lower (21% vs. 53%; P = 0.01). Ephedrine use and cardiac output were similar; umbilical pH was better in group A (7.34 ± 0.06 vs. 7.28 ± 0.06; P = 0.02).
CONCLUSION: Ultrasound-guided preload correction plus coloading reduces hypotension incidence, duration, rescue fluids, and maternal side effects in preload-dependent patients. Multicenter trials should validate integration into obstetric point of care ultrasounds protocols.
METHODS: In this randomized controlled trial (NCT07108881) conducted at the Tunis Maternity Center, 96 ASA II women with singleton pregnancies scheduled for elective cesarean under spinal anesthesia and preload dependent (ΔLVOT VTI ≥ 12% after passive leg raising via cardiac ultrasound) were enrolled (n=96) and randomized to one of two groups. The active group (A, n=48) received titrated crystalloid preloading (250 mL increments guided by serial LVOT VTI until < 12%) plus standard coloading (10 mL/kg) and the control group (C, n=48) received coloading alone. The primary outcome was the hypotension incidence (SBP decrease > 20% baseline). Secondary outcomes were hypotension duration, rescue fluids, ephedrine use, nausea/vomiting, Apgar scores, and umbilical pH.
RESULTS: Groups were comparable at baseline. Hypotension incidence was lower in group A vs C (37.5% vs. 62.5%; P < 0.001; RR = 0.6, 95% CI 0.39-0.91). Hypotension duration was shorter (2.9 ± 1.4 vs. 5.2 ± 1.6 min; P = 0.012), lowest SBP higher (88 ± 7 vs. 82 ± 9 mmHg; P < 0.001), rescue crystalloids reduced (365 ± 130 vs. 482 ± 116 mL; P = 0.04), and nausea/vomiting lower (21% vs. 53%; P = 0.01). Ephedrine use and cardiac output were similar; umbilical pH was better in group A (7.34 ± 0.06 vs. 7.28 ± 0.06; P = 0.02).
CONCLUSION: Ultrasound-guided preload correction plus coloading reduces hypotension incidence, duration, rescue fluids, and maternal side effects in preload-dependent patients. Multicenter trials should validate integration into obstetric point of care ultrasounds protocols.