Supine Versus Left Lateral Tilted Position During Cesarean Delivery

Phase 4

Interventions: Other: supine position
Other: left lateral tilted position
Drug: Bupivacaine

Brief Summary: In this study, we will investigate the effect of left lateral tiling performed after spinal block on maternal hemodynamics compared to ordinary supine position

Detailed Description: Maternal hypotension is a common complication after spinal anesthesia for cesarean delivery (CD). Aortocaval compression is one of the theoretical mechanisms precipitating for post-spinal hypotension (PSH) for CD. Positioning of the patients in the left lateral tilted position after preforming spinal block was frequently considered a standard protocol for minimizing aortocaval compression and improve maternal hemodynamics during CD; however, the latest Cochrane database review reported that there is no adequate evidence to support any positioning protocol for prevention of PSH. Moreover, a recent study was conducted in full term pregnant women reporting no improvement in cardiac output with left lateral tilting. In this study, the effect of left lateral tiling performed after spinal block on maternal hemodynamics will be compared to ordinary supine position.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
supine position	supine position	the patient will receive spinal anesthesia by Bupivacaine; then she will be placed in supine position
Left lateral tilted position	left lateral tilted position	the patient will receive spinal anesthesia by Bupivacaine; then she will be placed in left lateral tilted position
supine position	Bupivacaine	the patient will receive spinal anesthesia by Bupivacaine; then she will be placed in supine position
Left lateral tilted position	Bupivacaine	the patient will receive spinal anesthesia by Bupivacaine; then she will be placed in left lateral tilted position

Primary Outcome Measures

Name	Time	Method
postspinal hypotension	30 minutes after spinal anesthesia	The number of patients who develop hypotension (defined as decreased SBP less than 80% of the baseline reading during the period from intrathecal injection till delivery of the fetus) after spinal block divided by the total number in the group

Secondary Outcome Measures

Name	Time	Method
severe postspinal hypotension	30 minutes after spinal anesthesia	The number of patients who develop hypotension (defined as decreased SBP less than 60% of the baseline reading during the period from intrathecal injection till delivery of the fetus) after spinal block divided by the total number in the group
Post-delivery hypotension	10 minutes after delivery	number of patients who develop hypotension (defined as decreased SBP less than 80% of the baseline reading after delivery of the fetus and starting oxytocin infusion
systolic blood pressure	60 minutes after spinal block	systolic blood pressure measured in mmHg
diastolic blood pressure	60 minutes after spinal block	diastolic blood pressure measured in mmHg
incidence of nausea and vomiting	60 minutes after spinal block	number of patients who develop nausea and vomiting divided by the total number of patients in the group
ephedrine consumption	60 minutes after spinal block	total amount of ephedrine consumed during the operation (measured in milligrams)
Atropine consumption	60 minutes after spinal block	total amount of atropine consumed during the operation (measured in milligrams
heart rate	60 minutes after spinal block	heart rate measured in beats per minute
APGAR score	10 minute after delivery	APGAR score for detection of the well being of the fetus