Evidence-Based Clinical Practice Guidelines for Postspinal Hypotension in Pregnant Women

Abstract

Abstract Postspinal hypotension (PSH) in pregnant women undergoing a cesarean delivery is a common yet significant problem for the safety of the mother and fetus. The physiological effects of a spinal injection may compromise uteroplacental flow, predisposing the fetus to hypoxia and acidosis. Maternal consequences of prolonged hypotension include unstable hemodynamics, loss of consciousness, and nausea. Historically, healthcare providers have used crystalloid preloads and reactive phenylephrine boluses to correct hypotension. However, recent evidence suggests that these interventions have limited effectiveness. Thorough research led to the development of clinical guidelines that propose providing a 500 mL 6% hydroxyethyl starch preload or a 1000 mL Lactated Ringers coload in conjunction with a prophylactic variable-rate norepinephrine infusion immediately following the injection of the spinal anesthesia to avoid hypotension. For the project’s hypothetical implementation a hospital with a large obstetric unit will undergo pre- implementation measurements of several outcomes, including: incidence of hypotension, total vasopressor requirements, frequency of maternal bradycardia, and nausea. During a two-month trial implementation period, the proposed clinical guidelines will be implemented for all elective cesarean deliveries that meet the inclusion criteria. After two months, the Quality Improvement team and anesthesia leadership members will compare the new measurements to the baseline data. With the new guidelines in place, an anticipated decrease in the occurrence of postspinal hypotension, as well as the need for vasopressors, incidence of bradycardia, and nausea will occur in pregnant women undergoing cesarean deliveries