Randomised Controlled Trial on the Prevention of Post-Spinal Anaesthesia Hypotension in Caesarean Delivery using Delayed Supine Positioning

Background: Spinal anaesthesia is commonly used for caesarean deliveries due to its effectiveness and safety profile. However, it frequently causes hypotension, leading to maternal and fetal complications. Various strategies have been proposed to mitigate this, with maternal positioning being a key focus. Delayed supine positioning post-spinal anaesthesia has shown promise in reducing hypotension. This study aims to evaluate the efficacy of delayed supine positioning in preventing post-spinal anaesthesia hypotension in caesarean deliveries. Methods: Sixty pregnant women scheduled for elective caesarean delivery were randomised into two groups: delayed supine positioning (n=30) and immediate supine positioning (n=30). The primary outcome was the incidence of hypotension. Secondary outcomes included vasopressor requirements, incidence of nausea and vomiting, neonatal Apgar scores, and total intravenous fluid administration. Data were analysed using SPSS version 20.0. Results: The incidence of hypotension was significantly lower in the delayed supine group (20%) compared to the immediate supine group (50%, p=0.025). Vasopressor requirements were also reduced in the delayed supine group (p=0.035). The incidence of nausea and vomiting was significantly lower in the delayed supine group (p=0.046). Neonatal outcomes and total intravenous fluid administration were similar between the two groups. Conclusion: Delayed supine positioning significantly reduces the incidence of hypotension and vasopressor requirements in caesarean deliveries under spinal anaesthesia, without compromising neonatal outcomes. This technique enhances maternal safety and comfort during surgery. Recommendations: Based on these findings, delayed supine positioning should be considered as a standard practice to prevent hypotension in caesarean deliveries under spinal anaesthesia. Further studies with larger sample sizes and diverse populations are recommended to validate these results.