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A3044
October 21, 2019
10/21/2019 9:30:00 AM - 10/21/2019 11:30:00 AM
Room WA2 - Area D
Colloid Preload Versus Crystalloid Preload for Preventing Hypotension after Spinal Anesthesia in Women Undergoing Cesarean Section: A Systematic Review and Meta-analysis
Yuchao Shang, M.D., Huafeng Li, M.D., Junmei Ma, M.D., Yuying Tang, M.D., Shuying Li, M.D., Ping Li, M.D., Bo Sheng, M.D., Rurong Wang, M.D.
West China Second Hospital, Sichuan University, Chengdu, China
Disclosures: Y. Shang: None.H. Li: None.J. Ma: None.Y. Tang: None.S. Li: None.P. Li: None.B. Sheng: None.R. Wang: None.
Background

Maternal hypotension is the most frequent complication of spinal anaesthesia for caesarean section. Intravenous fluid pre-loading is one of measures to prevent hypotension. However, the advantages of colloid for pre-load remain controversial compared with crystalloid pre-load.

Objectives

We aimed to assess the efficacy of colloid vs crystalloid for pre-load at reducing spinal hypotension during cesarean delivery.

Search methods

We searched Cochrane Library, MEDLINE and EMBASE to identify all studies published up to October, 2018, through OVID and Pubmed, in any language.

Selection criteria

We included randomised controlled trials, comparing colloid pre-load with crystalloid pre-load in women having spinal anaesthesia for caesarean section. Primary outcomes were the incidence of hypotension and vasopressor requirement. Secondary outcomes included nausea and vomiting, Apgar scores and neonatal acidosis.

Data collection and analysis

Using standard forms, two authors independently extracted the data from eligible studies and assessed the risk of bias. We used mean differences (MDs) or standardised mean differences (SMDs) for expressing continuous outcomes and risk ratios (RRs) for dichotomous outcomes. We described the quality of evidence of each outcome by using the system developed by the GRADE Working Group.

Results

33 studies met the inclusion criteria, within which there were 2585 patients: 1291 received colloid pre-load and 1294 crystalloid. There were fewer women experienced hypotension in the colloid group compared with the crystalloid group (average RR 0.72, 95% CI 0.63 to 0.82; 2472 women; 31 studies, I2= 69%; very low-quality evidence). Stratification into subgroups was made according to the type and volume of colloid administered, we found that 7-10ml/kg or 500ml 6% hydroxyethyl starch(HES;130/0.4) pre-loading provided a lower incidence of hypotension(average RR 0.63, 95% CI 0.54 to 0.74; 1217 women; 18 studies, I2= 45%; low-quality evidence; Figure1). The total ephedrine dose required was significantly reduced with colloid pre-load (average Std.MD -0.33, 95% CI -0.61 to -0.05; 1453 women; 19 studies, I2= 85%; very low-quality evidence; Figure2). Rate of nausea and/or vomiting was lower in the colloid group (average RR 0.74, 95% CI 0.56 to 0.96; 1549 women; 20 studies, I2= 34%; low-quality evidence). There were no significant differences between two groups for neonatal Apgar score of less than 7 at one minutes (average RR 0.75, 95% CI 0.41 to 1.38, 526 babies; 6 studies, I2= 0%; low-quality evidence), as well as umbilical artery pH<7.2 (average RR 0.69, 95% CI 0.12 to 3.78, 2 studies, 276 babies; very low-quality evidence). There was no baby had a score of Apgar<7 at five minutes.

Authors’ conclusions

Colloid pre-loading is superior to crystalloid pre-loading in decreasing hypotension induced by spinal anaesthesia, ephedrine requirement and nausea and/or vomiting in the obstetrics population undergoing caesarean section. However, because of inconsistency between trials, lack of trials, risk of bias and highly imprecise results, more high quality RCTs investigating the requirement of phenylephrine, neonatal Apgar score and acidosis are needed.

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