Impact of leg elevation added to a 15˚ left lateral incline on maternal hypotension and neonatal outcomes in cesarean section: A randomized clinical study

Feyza Bolcal Çalışır; Aykut Urfalıoğlu; Neşe Yücel; Hafize Öksüz; Gözen Öksüz; Adem Doğaner; Ömer Faruk Boran

doi:10.28982/josam.559641

Authors

Feyza Bolcal Çalışır https://orcid.org/0000-0002-8882-4666
Aykut Urfalıoğlu https://orcid.org/0000-0002-0657-7578
Neşe Yücel https://orcid.org/0000-0002-5689-1311
Hafize Öksüz https://orcid.org/0000-0001-5963-6861
Gözen Öksüz https://orcid.org/0000-0001-5197-8031
Adem Doğaner https://orcid.org/0000-0002-0270-9350
Ömer Faruk Boran https://orcid.org/0000-0002-0262-9385

DOI:

https://doi.org/10.28982/josam.559641

Keywords:

Pregnancy, Cesarean section, Spinal anesthesia, Hypotension

Abstract

Aim: The supine position can cause maternofetal complications by exacerbating hypotension resulting from spinal anesthesia (SA). The aim of this study was to investigate and compare the effect of positioning the patient with a 15˚ left lateral incline and both positioning and elevating both legs on SA-induced hypotension.

Methods: This randomized clinical study was conducted on 200 pregnant women who underwent cesarean section in a university hospital between November 1, 2016 and April 15, 2017.

Pregnant women were separated into 2 groups as the 15˚ left lateral incline (Group 1) and the 15˚ left lateral incline and leg elevation group (Group 2). Mean arterial blood pressure (MAP) and heart rate (HR) values, ephedrine use, neonatal APGAR scores and umbilical cord vein blood gas analysis samples were compared at varying times. After administration of SA, MAP and HR were recorded at the second, fourth, sixth, eighth and tenth minutes until delivery of the infant, every five minutes after delivery until the 30th postpartum minute, and at the end of the surgery.

Results: Two and four minutes after the administration of SA and 20 minutes after delivery, mean HR values of group 2 were significantly higher than that of group 1 (P=0.002, P=0.005, P=0.006, respectively). MAP values were similar in both groups at all time points, however, a greater number of patients in group 1 had MAP <60 mmHg and HR <60 bpm at two and six minutes after the administration of SA.

Conclusion: Positioning the table at a 15˚ incline and leg elevation during ceasarian section may provide maternofetal benefits by reducing the frequency of post-spinal hypotension in pregnant women.

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