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Proactive haemodynamic management using the hypotension prediction index during caesarean section: a randomised

Po-Yuan Shih1, Tzu-Jung Wei1, Chen-Tse Lee1

  • 1Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.

Anaesthesia
|February 16, 2026
PubMed
Summary

Hypotension prediction index monitoring significantly reduced intra-operative hypotension during caesarean sections. This proactive approach also decreased maternal nausea and vomiting compared to other methods.

Keywords:
caesarean sectioncontinuous non‐invasive arterial pressurehypotensionhypotension prediction index

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Area of Science:

  • Obstetric Anesthesiology
  • Cardiovascular Monitoring
  • Machine Learning in Medicine

Background:

  • Intra-operative hypotension is a frequent complication during caesarean sections, potentially leading to adverse maternal outcomes like nausea and vomiting.
  • Current monitoring methods (oscillometric, continuous non-invasive arterial pressure) allow for reactive treatment of hypotension.
  • The hypotension prediction index (HPI) offers a machine learning-based, proactive approach to haemodynamic management.

Purpose of the Study:

  • To investigate if HPI-guided management could decrease the incidence of intra-operative hypotension during caesarean sections.
  • To compare the efficacy of HPI monitoring against oscillometric and continuous non-invasive arterial pressure monitoring in managing haemodynamics.
  • To assess the impact of different monitoring strategies on maternal adverse effects.

Main Methods:

  • Randomized controlled trial involving patients undergoing elective caesarean section under spinal anaesthesia.
  • Three groups were assigned: oscillometric blood pressure monitoring, continuous non-invasive arterial pressure monitoring, and HPI-guided monitoring.
  • Hypotension defined as mean arterial pressure < 65 mmHg, treated with noradrenaline; hypertension defined as ≥ 100 mmHg.

Main Results:

  • The HPI group demonstrated significantly lower time-weighted average hypotension (0.08 mmHg) compared to oscillometric (0.89 mmHg) and continuous non-invasive arterial pressure (0.30 mmHg) groups (p < 0.001).
  • The oscillometric group reported a higher incidence of maternal nausea (43/59) and vomiting (13/59) compared to the other two groups.
  • No significant increase in intra-operative hypertension was noted in the HPI group.

Conclusions:

  • HPI-guided management effectively reduces intra-operative hypotension in caesarean sections.
  • This proactive monitoring strategy improves haemodynamic stability and reduces maternal adverse effects.
  • HPI represents a valuable tool for optimising anaesthetic care in obstetric patients.