Cochrane · systematic review · CD002251
Techniques for preventing hypotension during spinal anaesthesia for caesarean section
Chooi, C, Cox, JJ, Lumb, RS, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
48
current version
GRADE rated
31
No studies
17
Included studies
NR
No studies 17 · 35.4%Ungraded 0 · 0%Very low 18 · 37.5%Low 13 · 27.1%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyTechniques for preventing hypotension during spinal anaesthesia for caesarean section: key interventions for the primary outcome (women with hypotension requiring intervention)
Population: women having spinal anaesthesia for caesarean section
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Crystalloid vs control | RR 0.84 [0.72, 0.98] | 5 studies · 370 participants | Low |
Colloid vs crystalloid | RR 0.68 [0.58, 0.8] | 28 studies · 2105 participants | Very low Downgraded: risk of bias, inconsistency |
Ephedrine vs phenylephrine | RR 0.92 [0.71, 1.18] | 8 studies · 401 participants | Very low Downgraded: imprecision, inconsistency |
Ondansetron vs control | RR 0.67 [0.54, 0.83] | 8 studies · 740 participants | Low Downgraded: risk of bias, imprecision |
Lower limb compression vs control | RR 0.61 [0.47, 0.78] | 11 studies · 705 participants | Very low Downgraded: risk of bias, inconsistency |
Walking vs lying | RR 0.71 [0.41, 1.21] | 1 study · 37 participants | Very low Downgraded: risk of bias, imprecision |
Crystalloid versus control
Population: women having spinal anaesthesia for caesarean section
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal hypotension requiring intervention Crystalloid vs control | RR 0.84 [0.72, 0.98] | 5 studies · 370 participants | Low Downgraded: imprecision |
Maternal hypertension requiring intervention Crystalloid vs control | no estimate extracted | NR | No studies |
Maternal bradycardia requiring intervention Crystalloid vs control | no estimate extracted | NR | No studies |
Maternal nausea and/or vomiting Crystalloid vs control | RR 0.19 [0.01, 3.91] | 1 study · 69 participants | Very low Downgraded: imprecision |
Neonatal acidosis as defined by cord or neonatal blood with a pH < 7.2 Crystalloid vs control | no estimate extracted | NR | No studies |
Neonatal Apgar score < 8 at 5 minutes Crystalloid vs control | no estimate extracted | 1 study · 60 participants | Low Downgraded: imprecision |
Admission to neonatal intensive care unit Crystalloid vs control | no estimate extracted | NR | No studies |
Colloid versus crystalloid
Population: women having spinal anaesthesia for caesarean section
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal hypotension requiring intervention Colloid vs crystalloid | RR 0.69 [0.58, 0.81] | 27 studies · 2009 participants | Very low Downgraded: risk of bias, inconsistency |
Maternal hypertension requiring intervention Colloid vs crystalloid | RR 0.64 [0.09, 4.46] | 3 studies · 327 participants | Very low Downgraded: imprecision |
Maternal bradycardia requiring intervention Colloid vs crystalloid | RR 0.98 [0.54, 1.78] | 5 studies · 413 participants | Very low Downgraded: imprecision |
Maternal nausea and/or vomiting Colloid vs crystalloid | RR 0.89 [0.66, 1.19] | 14 studies · 1058 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Neonatal acidosis as defined by cord or neonatal blood with a pH < 7.2 Colloid vs crystalloid | RR 0.83 [0.15, 4.52] | 6 studies · 678 participants | Very low Downgraded: imprecision |
Neonatal Apgar score < 8 at 5 minutes Colloid vs crystalloid | RR 0.24 [0.03, 2.05] | 10 studies · 730 participants | Very low Downgraded: imprecision |
Admission to neonatal intensive care unit Colloid vs crystalloid | no estimate extracted | NR | No studies |
Ephedrine versus phenylephrine
Population: women having spinal anaesthesia for caesarean section
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal hypotension requiring intervention Ephedrine vs phenylephrine | RR 0.92 [0.71, 1.18] | 8 studies · 401 participants | Very low Downgraded: imprecision, inconsistency |
Maternal hypertension requiring intervention Ephedrine vs phenylephrine | RR 1.72 [0.71, 4.16] | 2 studies · 118 participants | Low Downgraded: imprecision |
Maternal bradycardia requiring intervention Ephedrine vs phenylephrine | RR 0.37 [0.21, 0.64] | 5 studies · 304 participants | Low Downgraded: imprecision |
Maternal nausea and/or vomiting Ephedrine vs phenylephrine | RR 0.76 [0.39, 1.49] | 4 studies · 204 participants | Very low Downgraded: imprecision, inconsistency |
Neonatal acidosis as defined by cord or neonatal blood with a pH < 7.2 Ephedrine vs phenylephrine | RR 0.89 [0.07, 12] | 3 studies · 175 participants | Low |
Neonatal Apgar score < 8 at 5 minutes Ephedrine vs phenylephrine | no estimate extracted | 6 studies · 321 participants | Low Downgraded: imprecision |
Admission to neonatal intensive care unit Ephedrine vs phenylephrine | no estimate extracted | NR | No studies |
Ondansetron versus control
Population: women having spinal anaesthesia for caesarean section
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal hypotension requiring intervention Ondansetron vs control | RR 0.67 [0.54, 0.83] | 8 studies · 740 participants | Low Downgraded: imprecision |
Maternal hypertension requiring intervention Ondansetron vs control | no estimate extracted | NR | No studies |
Maternal bradycardia requiring intervention Ondansetron vs control | RR 0.49 [0.28, 0.87] | 8 studies · 740 participants | Low Downgraded: imprecision |
Maternal nausea and/or vomiting Ondansetron vs control | RR 0.35 [0.24, 0.51] | 7 studies · 653 participants | Low Downgraded: imprecision |
Neonatal Apgar score < 8 at 5 minutes Ondansetron vs control | no estimate extracted | 3 studies · 284 participants | Low Downgraded: imprecision |
Neonatal acidosis as defined by cord or neonatal blood with a pH < 7.2 Ondansetron vs control | RR 0.48 [0.05, 5.09] | 2 studies · 134 participants | Low Downgraded: imprecision |
Admission to neonatal care unit Ondansetron vs control | no estimate extracted | NR | No studies |
Lower limb compression versus control
Population: women having spinal anaesthesia for caesarean section
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal hypotension requiring intervention Lower limb compression vs control | RR 0.61 [0.47, 0.78] | 11 studies · 705 participants | Very low Downgraded: risk of bias, inconsistency |
Maternal hypertension requiring intervention Lower limb compression vs control | no estimate extracted | NR | No studies |
Maternal bradycardia requiring intervention Lower limb compression vs control | RR 0.63 [0.11, 3.56] | 1 study · 74 participants | Very low Downgraded: imprecision |
Maternal nausea and/or vomiting Lower limb compression vs control | RR 0.42 [0.14, 1.27] | 4 studies · 276 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Neonatal acidosis as defined by cord or neonatal blood with a pH < 7.2 Lower limb compression vs control | no estimate extracted | NR | No studies |
Neonatal Apgar score < 8 at 5 minutes Lower limb compression vs control | no estimate extracted | 3 studies · 130 participants | Very low Downgraded: risk of bias, imprecision |
Admission to neonatal intensive care unit Lower limb compression vs control | no estimate extracted | NR | No studies |
Walking versus lying
Population: women having spinal anaesthesia for caesarean section
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal hypotension requiring intervention Walking vs lying | RR 0.71 [0.41, 1.21] | 1 study · 37 participants | Very low Downgraded: risk of bias, imprecision |
Maternal hypertension requiring intervention Walking vs lying | no estimate extracted | NR | No studies |
Maternal bradycardia requiring intervention Walking vs lying | no estimate extracted | NR | No studies |
Maternal nausea and/or vomiting Walking vs lying | no estimate extracted | NR | No studies |
Neonatal acidosis as defined by cord or neonatal blood with a pH < 7.2 Walking vs lying | no estimate extracted | NR | No studies |
Neonal Apgar score < 8 at 5 minutes Walking vs lying | no estimate extracted | NR | No studies |
Admission to neonatal intensive care unit Walking vs lying | no estimate extracted | NR | No studies |
Techniques for preventing hypotension during spinal anaesthesia for caesarean section: key interventions for the primary outcome (women with hypotension requiring intervention)
Population: women having spinal anaesthesia for caesarean section
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Crystalloid vs control | RR 0.84 [0.72, 0.98] | 5 studies · 370 participants | Low |
Colloid vs crystalloid | RR 0.68 [0.58, 0.8] | 28 studies · 2105 participants | Very low Downgraded: risk of bias, inconsistency |
Ephedrine vs phenylephrine | RR 0.92 [0.71, 1.18] | 8 studies · 401 participants | Very low Downgraded: imprecision, inconsistency |
Ondansetron vs control | RR 0.67 [0.54, 0.83] | 8 studies · 740 participants | Low Downgraded: risk of bias, imprecision |
Lower limb compression vs control | RR 0.61 [0.47, 0.78] | 11 studies · 705 participants | Very low Downgraded: risk of bias, inconsistency |
Walking vs lying | RR 0.71 [0.41, 1.21] | 1 study · 37 participants | Very low Downgraded: risk of bias, imprecision |
Crystalloid versus control
Population: women having spinal anaesthesia for caesarean section
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal hypotension requiring intervention Crystalloid vs control | RR 0.84 [0.72, 0.98] | 5 studies · 370 participants | Low Downgraded: imprecision |
Maternal hypertension requiring intervention Crystalloid vs control | no estimate extracted | NR | No studies |
Maternal bradycardia requiring intervention Crystalloid vs control | no estimate extracted | NR | No studies |
Maternal nausea and/or vomiting Crystalloid vs control | RR 0.19 [0.01, 3.91] | 1 study · 69 participants | Very low Downgraded: imprecision |
Neonatal acidosis as defined by cord or neonatal blood with a pH < 7.2 Crystalloid vs control | no estimate extracted | NR | No studies |
Neonatal Apgar score < 8 at 5 minutes Crystalloid vs control | no estimate extracted | 1 study · 60 participants | Low Downgraded: imprecision |
Admission to neonatal intensive care unit Crystalloid vs control | no estimate extracted | NR | No studies |
Colloid versus crystalloid
Population: women having spinal anaesthesia for caesarean section
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal hypotension requiring intervention Colloid vs crystalloid | RR 0.68 [0.58, 0.8] | 28 studies · 2105 participants | Very low Downgraded: risk of bias, inconsistency |
Maternal hypertension requiring intervention Colloid vs crystalloid | RR 0.64 [0.09, 4.46] | 3 studies · 327 participants | Very low Downgraded: imprecision |
Maternal bradycardia requiring intervention Colloid vs crystalloid | RR 0.99 [0.55, 1.79] | 6 studies · 509 participants | Very low Downgraded: imprecision |
Maternal nausea and/or vomiting Colloid vs crystalloid | RR 0.83 [0.61, 1.13] | 15 studies · 1154 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Neonatal acidosis as defined by cord or neonatal blood with a pH < 7.2 Colloid vs crystalloid | RR 0.83 [0.15, 4.52] | 6 studies · 678 participants | Very low Downgraded: imprecision |
Neonatal Apgar score < 8 at 5 minutes Colloid vs crystalloid | RR 0.24 [0.03, 2.05] | 11 studies · 826 participants | Very low Downgraded: imprecision |
Admission to neonatal intensive care unit Colloid vs crystalloid | no estimate extracted | NR | No studies |
Ephedrine versus phenylephrine
Population: women having spinal anaesthesia for caesarean section
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal hypotension requiring intervention Ephedrine vs phenylephrine | RR 0.92 [0.71, 1.18] | 8 studies · 401 participants | Very low Downgraded: imprecision, inconsistency |
Maternal hypertension requiring intervention Ephedrine vs phenylephrine | RR 1.72 [0.71, 4.16] | 2 studies · 118 participants | Low Downgraded: imprecision |
Maternal bradycardia requiring intervention Ephedrine vs phenylephrine | RR 0.37 [0.21, 0.64] | 5 studies · 304 participants | Low Downgraded: imprecision |
Maternal nausea and/or vomiting Ephedrine vs phenylephrine | RR 0.76 [0.39, 1.49] | 4 studies · 204 participants | Very low Downgraded: imprecision, inconsistency |
Neonatal acidosis as defined by cord or neonatal blood with a pH < 7.2 Ephedrine vs phenylephrine | RR 0.89 [0.07, 12] | 3 studies · 175 participants | Low |
Neonatal Apgar score < 8 at 5 minutes Ephedrine vs phenylephrine | no estimate extracted | 6 studies · 321 participants | Low Downgraded: imprecision |
Admission to neonatal intensive care unit Ephedrine vs phenylephrine | no estimate extracted | NR | No studies |
Ondansetron versus control
Population: women having spinal anaesthesia for caesarean section
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal hypotension requiring intervention Ondansetron vs control | RR 0.67 [0.54, 0.83] | 8 studies · 740 participants | Low Downgraded: imprecision |
Maternal hypertension requiring intervention Ondansetron vs control | no estimate extracted | NR | No studies |
Maternal bradycardia requiring intervention Ondansetron vs control | RR 0.49 [0.28, 0.87] | 8 studies · 740 participants | Low Downgraded: imprecision |
Maternal nausea and/or vomiting Ondansetron vs control | RR 0.35 [0.24, 0.51] | 7 studies · 653 participants | Low Downgraded: imprecision |
Neonatal Apgar score < 8 at 5 minutes Ondansetron vs control | no estimate extracted | 3 studies · 284 participants | Low Downgraded: imprecision |
Neonatal acidosis as defined by cord or neonatal blood with a pH < 7.2 Ondansetron vs control | RR 0.48 [0.05, 5.09] | 2 studies · 134 participants | Low Downgraded: imprecision |
Admission to neonatal care unit Ondansetron vs control | no estimate extracted | NR | No studies |
Lower limb compression versus control
Population: women having spinal anaesthesia for caesarean section
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal hypotension requiring intervention Lower limb compression vs control | RR 0.61 [0.47, 0.78] | 11 studies · 705 participants | Very low Downgraded: risk of bias, inconsistency |
Maternal hypertension requiring intervention Lower limb compression vs control | no estimate extracted | NR | No studies |
Maternal bradycardia requiring intervention Lower limb compression vs control | RR 0.63 [0.11, 3.56] | 1 study · 74 participants | Very low Downgraded: imprecision |
Maternal nausea and/or vomiting Lower limb compression vs control | RR 0.42 [0.14, 1.27] | 4 studies · 276 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Neonatal acidosis as defined by cord or neonatal blood with a pH < 7.2 Lower limb compression vs control | no estimate extracted | NR | No studies |
Neonatal Apgar score < 8 at 5 minutes Lower limb compression vs control | no estimate extracted | 3 studies · 130 participants | Very low Downgraded: risk of bias, imprecision |
Admission to neonatal intensive care unit Lower limb compression vs control | no estimate extracted | NR | No studies |
Walking versus lying
Population: women having spinal anaesthesia for caesarean section
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal hypotension requiring intervention Walking vs lying | RR 0.71 [0.41, 1.21] | 1 study · 37 participants | Very low Downgraded: risk of bias, imprecision |
Maternal hypertension requiring intervention Walking vs lying | no estimate extracted | NR | No studies |
Maternal bradycardia requiring intervention Walking vs lying | no estimate extracted | NR | No studies |
Maternal nausea and/or vomiting Walking vs lying | no estimate extracted | NR | No studies |
Neonatal acidosis as defined by cord or neonatal blood with a pH < 7.2 Walking vs lying | no estimate extracted | NR | No studies |
Neonal Apgar score < 8 at 5 minutes Walking vs lying | no estimate extracted | NR | No studies |
Admission to neonatal intensive care unit Walking vs lying | no estimate extracted | NR | No studies |