Techniques to prevent hypotension during a caesarean section under lumbar hemp.

BACKGROUND: Low maternal blood pressure is the most common complication during a lower-waist caesarean section.
may be associated with nausea or vomiting and may pose a serious threat to maternal (stun, pulmonary suction) and infant (hypoxia, acidosis, nerve damage).
purpose: to evaluate the effect of preventive intervention for hypotension during a lower-lumbar caesarean section.
: Search the Cochrane Pregnancy and Childbirth Pilot Register (August 9, 2016) and a list of research references retrieved.
Selection Criteria: Included mainly in randomized controlled trials, including full text and abstracts, these trials compared the effectiveness of interventions to prevent hypotension, compared to placebo or alternative therapies to prevent maternal hypotension during lumbar caesarean section.
we ruled out studies where low blood pressure was not an indicator of observation.
and analysis: The authors independently assessed the quality of the study and extracted data from eligible studies.
we use the GRADE system to report the "Summary of Results" table.
: The study included 125 studies involving 9,469 women.
interventions are only used to prevent hypotension in women who have a lower-waist caesarean section, we have ruled out any interventions that consider active treatment.
all the included studies reported the main findings of the review.
49 comparisons, we identified three intervention groups: intravenous fluids, drug interventions, and physical interventions.
all of the study's authors reported that none of the interventions surveyed had serious side effects.
most trials reported low blood pressure requiring intervention and apgar scores of less than 8 out of 5 as the only observational indicator.
in the comparison we described, none of the trials reported when newborns entered the intensive care unit.
crystal fluid group compared to control group (no infusion): fewer women with low blood pressure in crystal fluid group (average relative risk (RR): 0.84, 95% CI: 0.72-0.98; 370 women; 5 studies; low quality evidence); nausea and vomiting between the two groups There was no significant difference in the number of mothers (average RR: 0.19, 95% CI: 0.01-3.91; 1 study; 69 women; very low quality evidence);
colline groups compared to crystal fluid groups: fewer mothers with low blood pressure in colletoic fluid groups (average RR: 0.69, 95% CI: 0.58-0.81; 2009 women; 27 studies; very low quality evidence); maternal interventions required Hypertension (average RR: 0.64, 95% CI: 0.09-4.46, 3 studies, 327 women; very low quality evidence), hypertension in women requiring intervention (average RR: 0.98, 95% CI: 0. 54-1.78, 5 studies, 413 women; very low quality evidence), nausea and/or vomiting (average RR: 0.89, 95% CI: 0.66-1.19, 14 studies, 1058 women, I 2 - 29%; Very low quality evidence), neonatal acidosis (average RR: 0.83, 95% CI: 0.15-4.52, 6 studies, 678 infants; very low quality evidence) or 5min Apgar score below 8 (average RR). :: 0.24,95% CI: 0.03-2.05, 10 studies, 730 infants; very low quality evidence) there was no significant difference between groups.
ephedrine and epinephrine in preventing maternal hypotension (average RR: 0.92, 95% CI: 0.71-1.18; 401 women; 8 studies There was no significant difference in very low quality evidence) or hypertension (average RR: 1.72, 95% CI was 0.71-4.16, 2 studies, 118 women, low quality evidence).
rate of titulum overtensiveness was low in the ephedrine group (average RR was 0.37, 95% CI was 0.21 to 0.64, 5 studies, 304 women, low quality evidence).
addition, women with nausea and/or vomiting (average RR: 0.76, 95% CI: 0.39-1.49, 4 studies, 204 women, I2 x 37%, very low quality There was no significant difference between the groups of evidence) or the number of infants with neonatal acidosis (average RR: 0.89, 95% CI: 0.07-12.00, 3 studies, 175 infants, low quality evidence).
two groups (321 infants; low-quality evidence), none had an Apgar score of less than 8 out of 5.
on preventing hypotension in need of treatment (average RR: 0.67, 95% CI: 0.54-0.83; 740 women, 8 studies, low quality evidence), heart movements in need of treatment Slow (average RR: 0.49, 95% CI: 0.28-0.87; 740 women, 8 studies, low quality evidence) and nausea and/or vomiting (average RR: 0.35, 95% CI: 0.24-0.51; 653 women, 7 studies, low quality evidence) more effective than control group (placebo physiological saline); neonatal acidosis (average RR: 0.48,9 5%CI: 0.05-5.09; 134 infants; 2 studies, low-quality evidence) or 5 min apgar scores below 8 points (284 infants, low evidence quality) did not show significant differences between the occurrence groups.
Lower limb bandage pressure was more effective than the control group in preventing hypotension (average RR was 0.61, 95% CI was 0.47 to 0.78, 11 studies, 705 women, I2 x 65%, very low quality evidence); CI 0.11 to 3.56, 1 study, 74 women, very low quality of evidence) or nausea and/or vomiting (average RR0.42, 95% CI 0.14 to 1.27, 4 studies, 276 women, I2 - 32%, very low evidence) there was no significant difference; In either group, none of the infants had an Apgar score of less than 8 out of 5 min (130 babies, with very low quality evidence).
, walking comparison flat sleep: for women with low blood pressure in need of treatment, there was no significant difference in walking and lying flat (RR: 0.71, 95% CI: 0.41-1.21, 1 study, 37 women, very low quality evidence).
that many of the included studies have little or no information to assess their bias risks, limiting our ability to draw meaningful conclusions.
assessment of the quality of the evidence ranges from very low to very low.
evidence that we have reduced the limitations, insecration, and indirectness of research design; most studies only assess women who plan to have a caesarean section.
effectiveness also needs to be considered.
considering the serious potential side effects of colloids, such as allergies and kidney failure, readers should be alert to the use of colloids in this area.
Conclusion: While interventions such as crystals, colloids, ephedrine, epinephrine, Ondansjun or lower limb bandages can reduce the rate of hypotension, none of them can effectively reduce the need for treatment for maternal hypotension.
the relatively small number of mothers studied, we cannot draw any conclusions about the rare adverse reactions associated with the interventions used, such as collusion.
sources: Chooi C, Cox JJ, Lumb RS, et al. Betweens for the preventing hypotension between spinal anaesthesia for caesarean section. (J) Cochrane Database Syst Rev, 2020, 7: CD002251. Translation: He Yuqin Editor: Feng Yuqin Review: Cao Ying Source: Poppy !-- Content Display Ends - !-- Determine whether the login ends.