Table Tilt versus Pelvic Tilt Position for Intrauterine Resuscitation during Spinal Anesthesia for Caesarian Section

Abstract

IntroductionIntrauterine resuscitation has been proved to increase the oxygenation of placenta and umbilical blood flow. Lateral table tilt or a pelvic wedge are commonly used to reduce inferior vena cava compression during obstetric anesthesia in the supine position but limited studies have evaluated the role of intrauterine resuscitation by maneuvers. We compared the effects of table tilt versus pelvic tilt position on intrauterine resuscitation for caesarian section under spinal anesthesia.Material and methodsThis double blind randomized clinical trial conducted on 150 women undergoing cesarean section. Patients were randomly allocated to pelvic tilt (using a wedge under right buttock) or table tilt (15 degree left tilt of surgical table). Spinal anesthesia was performed, Sensory and motor block were evaluated every minute and time of block onset was recorded. Mean arterial blood pressure, heart rate and arterial oxygen saturation were measured every 5 minutes till the end of the operation. Fetal Apgar scores were recorded at 1st and 5th minutes after delivery. Data were analyzed using SPSS software.ResultsMAP and HR were significantly higher in table tilt group in comparison with pelvic tilt (p< 0/05). No significant difference was detected between the two groups in terms of sensory and motor block (p>0/05). Apgar scores of neonates were almost the same and no statistically significant differences between the two groups in 1st and 5th minutes Apgar score was noted(p>0/05).ConclusionsTable tilt of 15 degrees during cesarean delivery with spinal anesthesia was effective in preventing maternal hypotension and bradycardia and is favorable in intrauterine resuscitation.