Maternal position during caesarean section for preventing maternal and neonatal complications

Area of Science:

• Obstetrics and Gynecology
• Surgical Patient Positioning
• Anesthesiology

Background:

• Maternal positioning during caesarean section lacks a standardized consensus.
• Various methods like table tilting, wedges, and cushions are employed without clear evidence of superiority.
• Optimizing patient position is crucial for surgical safety and maternal outcomes.

Purpose of the Study:

• To systematically review existing data on maternal positioning during caesarean sections.
• To determine if a specific maternal position improves surgical or maternal outcomes.
• To provide evidence-based recommendations for caesarean section positioning.

Main Methods:

• Comprehensive search of Cochrane Pregnancy and Childbirth Group's Trials Register and PubMed.
• Inclusion of randomized trials comparing different maternal positions during caesarean section.
• Data extraction and quality assessment by two independent reviewers.

Main Results:

• Analysis of 11 randomized trials involving 857 women, with limitations due to small sample sizes and single-trial comparisons.
• No significant difference in air embolism incidence across head-up versus horizontal positions.
• Manual displacers showed a decrease in hypotensive episodes compared to left lateral tilt; left lateral tilt may be superior to right lateral tilt.

Conclusions:

• Limited evidence exists to definitively support or refute the use of various positioning techniques (tilting, wedges, displacers).
• A left lateral tilt and manual displacers show potential advantages but require further investigation.
• Larger, high-quality studies are necessary to establish optimal maternal positioning for caesarean sections.