Rees 2002.
| Study characteristics | ||
| Methods | RCT | |
| Participants | 60 women Inclusion criteria: healthy women undergoing elective caesarean Exclusion criteria: women with symptoms or signs of labour, prematurity (< 37 weeks' gestation), multiple pregnancy, hypertension, pre‐eclampsia, obesity, intrauterine growth retardation, fetal distress or any other factor contraindicating a standard spinal anaesthetic technique Setting: UK |
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| Interventions |
Left lateral versus left lateral tilt Group 1: full left lateral after spinal Group 2: 15 degree left lateral table tilt from supine after spinal Women remained in the study position for 15 min after spinal anaesthesia; women in the left lateral group were then turned into the 15 degree tilt position. All women received a standardised crystalloid preload, a standardised spinal anaesthetic technique and dose, and 6 mg ephedrine IV immediately after insertion of spinal anaesthetic. |
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| Outcomes |
Maternal: hypotension; block height; ephedrine dose; nausea; vomiting; bradycardia; maximum percentage decrease in arm SAP; maximum percentage decrease in leg SAP; fetal heart traces Neonatal: Apgar scores (presented as means and ranges); venous cord gases (presented as means only); arterial cord gases (presented as means only) |
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| Notes | Hypotension was defined as SAP of either less than 100 mmHg or less than 80% of baseline. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Stratified by cephalic or breech presentation (separate random‐number lists) |
| Allocation concealment (selection bias) | Unclear risk | Sealed envelopes prepared in advance by a third party |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Blinding not stated |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Blinding not stated |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Losses to follow‐up: 2/60 – 1 from each group: in 1 woman, the anaesthetist was unable to site the spinal in the lateral position and the spinal was subsequently successfully inserted in the sitting position; another withdrawal (from the lateral group) was due to inadequate spread of spinal blockade |
| Selective reporting (reporting bias) | Unclear risk | Unclear reporting |
| Other bias | Unclear risk | Unclear reporting |