Kim Ji-Na, Sim Kyu Man, Hwang Jung-Won, Do Sang-Hwan, Na Hyo-Seok
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi 173, Bundang, Seongnam, 13620, South Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea.
BMC Pregnancy Childbirth. 2025 Dec 5;25(1):1340. doi: 10.1186/s12884-025-08540-w.
Supine hypotension syndrome, caused by aortocaval compression of the gravid uterus in the supine position, is a common concern during cesarean delivery, particularly in women with multiple gestations. This retrospective study aimed to determine whether the use of a lumbar wedge reduces intraoperative hypotension in women with multiple gestations undergoing cesarean delivery under spinal anesthesia.
A total of 199 women with multiple gestations who underwent cesarean delivery under spinal anesthesia were included. Participants were divided into two groups based on lumbar wedge application: wedge ( = 108) and horizontal ( = 91). The primary outcome was the incidence of intraoperative hypotension, defined as the need for vasopressors (phenylephrine or ephedrine) at least once during surgery. Secondary outcomes included the total administered vasopressor dose and neonatal outcomes.
The incidence of intraoperative hypotension was significantly lower in the wedge group than in the horizontal group (70.4% vs. 86.8%; = 0.005; RR, 0.8; 95% CI, 0.7 to 0.9). Phenylephrine requirements were significantly lower in the wedge group than in the horizontal group (4.0 ± 5.7 vs. 7.0 ± 7.7 µg/min; mean difference, -3.0; 95% CI, -4.9 to -1.1; = 0.002), as were ephedrine requirements (0.04 ± 0.07 vs. 0.10 ± 0.13 mg/min; mean difference, -0.06; 95% CI, -0.09 to -0.03; < 0.001). Neonatal cord blood gas values were within normal ranges, although some parameters differed significantly between groups. Specifically, the PCO levels of the first and third infants ( = 0.024 and 0.025, respectively), and the HCO and base excess values of the second infant ( = 0.025 and 0.011, respectively), differed significantly between the wedge and horizontal groups.
The use of a lumbar wedge in patients with multiple gestations was associated with a significant reduction in the incidence of intraoperative hypotension during cesarean delivery under spinal anesthesia. These findings suggest that lumbar wedge positioning may be a simple, low-cost, and easily applicable technique to potentially enhance maternal hemodynamic stability and improve perioperative safety in multiple gestation pregnancies.
The online version contains supplementary material available at 10.1186/s12884-025-08540-w.
仰卧位低血压综合征是由于妊娠子宫在仰卧位时压迫主动脉和下腔静脉所致，是剖宫产术中常见的问题，尤其是在多胎妊娠妇女中。这项回顾性研究旨在确定使用腰部楔形垫是否能降低接受腰麻剖宫产的多胎妊娠妇女术中低血压的发生率。
共纳入199例接受腰麻剖宫产的多胎妊娠妇女。根据是否使用腰部楔形垫将参与者分为两组：楔形垫组（n = 108）和水平组（n = 91）。主要结局是术中低血压的发生率，定义为手术期间至少需要使用一次血管升压药（去氧肾上腺素或麻黄碱）。次要结局包括血管升压药的总使用剂量和新生儿结局。
楔形垫组术中低血压的发生率显著低于水平组（70.4% 对86.8%；P = 0.005；RR，0.8；95% CI，0.7至0.9）。楔形垫组去氧肾上腺素的需求量显著低于水平组（4.0±5.7 vs. 7.0±7.7 μg/min；平均差值，-3.0；95% CI，-4.9至-1.1；P = 0.002），麻黄碱的需求量也是如此（0.04±0.07 vs. 0.10±0.13 mg/min；平均差值，-0.06；95% CI，-0.09至-0.03；P < 0.001）。新生儿脐血气值在正常范围内，尽管两组之间的一些参数存在显著差异。具体而言，楔形垫组和水平组之间，第一和第三个婴儿的PCO₂水平（分别为P = 0.024和0.025）以及第二个婴儿的HCO₃⁻和碱剩余值（分别为P = 0.025和0.011）存在显著差异。
在多胎妊娠患者中使用腰部楔形垫与腰麻剖宫产术中低血压发生率的显著降低相关。这些发现表明，腰部楔形垫定位可能是一种简单、低成本且易于应用的技术，有可能增强母体血流动力学稳定性并提高多胎妊娠围手术期安全性。
在线版本包含可在10.1186/s12884-025-08540-w获取的补充材料。
