Manual Leftward Displacement of the Uterus in the Prevention of Maternal Hypotension During Cesarean Section: A Randomized Comparative Study

 It is essential to maintain the hemodynamic state of mothers during delivery in cesarean section (CS). Research has shown that hypotension can be controlled by applying a 15° left lateral tilt. This can be achieved using an obstetric wedge or by tilting the operating table leftward. A systematic review of further research shows insufficient evidence to suggest whether it is effective or practical.

 This study aims to evaluate the effectiveness of manual left tilting of the uterus on maintaining the hemodynamic status of mothers undergoing a CS delivery, where a spinal anesthetic has been given.

 Seventy women who were candidates for CS deliveries were randomly assigned into 2 groups as follows: group 1, the anaesthesiologist manually maneuvered the mother’s uterus to the left shortly after spinal anesthesia; group 2, the mothers’ uteruses were not displaced to the left. Sixty-seven of 70 participants completed the study. The hemodynamic status of the mother was reported before, during, and after surgery. The total doses of inotropic-vasopressors used to maintain hemodynamic stability were recorded.

 The mother’s age, vital signs, and body mass index (BMI) before pregnancy and near term were not significantly different. Mothers maintained a significantly higher systolic blood pressure (SBP) when the uterus was displaced to the left (group 1). The mothers also required less ephedrine. Mothers in group 2 suffered a greater decrease in their SBP both after induction and before incision of the abdomen (group 2, P < 0.05).

 The manual tilting of the uterus to the left during CS is effective in maintaining blood pressure and decreases the need for vasopressors.