Effect of preoperative warming of parturients on blood loss during Cesarean section under spinal anesthesia: A Randomized Controlled Trial {HeAT-PS Hemorrhage Assessment after Thermoregulation in Parturient under Spinal anesthesia.}

Summary This randomized controlled trial investigates the impact of preoperative warming on blood loss during cesarean section under spinal anesthesia. Cesarean sections are increasingly common, with maternal hemorrhage a leading cause of morbidity and mortality in India, particularly among anemic parturients. Spinal anesthesia often causes vasodilation and hypothermia, exacerbating bleeding risks. Preoperative warming has shown promise in minimizing these effects by maintaining normothermia and improving coagulation.

The study hypothesizes that active prewarming can reduce intraoperative blood loss, enhance thermal comfort, reduce shivering, and improve maternal and neonatal outcomes. A total of 132 participants scheduled for elective cesarean sections under spinal anesthesia will be enrolled at AIIMS Nagpur. They will be randomly assigned to two groups: the Control Group (C), which will receive standard care without active warming, and the Prewarming Group (P), which will receive 20 minutes of forced-air warming and warm IV fluids.

The primary objective is to compare intraoperative blood loss between the groups. Secondary objectives include evaluating the incidence of hypothermia and shivering, assessing maternal thermal comfort, and measuring neonatal outcomes (umbilical blood gas values and Apgar scores at 1 and 5 minutes). Blood loss will be quantified using suction volumes, blood-soaked materials, and postoperative hemoglobin changes. Core temperature will be monitored at multiple time points, and thermal comfort and shivering will be graded using established scales.

The study duration is 16 months, with ethical and CTRI approvals obtained prior to initiation. Data will be analyzed using SPSS software, applying appropriate statistical tests. This research aims to demonstrate that preoperative warming is a simple, feasible intervention that can significantly improve safety and outcomes for parturients undergoing cesarean sections under spinal anesthesia.