Romdhani 2014.

Study characteristics
Methods	RCT
Participants	105 patients undergoing elective caesarean section Inclusion criteria: term singleton pregnancies, not in labour, elective caesarean, appropriate for spinal anaesthesia Exclusion criteria: pre‐eclampsia, weight > 110 kg, < 150 cm tall, allergy to HES, known fetal abnormalities, contraindication for spinal anaesthesia, sensitive block height that exceeded T4, haemodynamic instability caused by a surgical complication, failed spinal anaesthesia Setting: Tunisia
Interventions	HES vs crystalloid preload Group 1: 500 mL of 6% HES 130/0.4 Group 2: 1500 mL of 9% normal saline solution Both groups received bolus 30 min prior to spinal anaesthesia Both groups received rescue ephedrine
Outcomes	Maternal: hypotension; heart rate; dose of ephedrine; nausea and vomiting Neonatal: umbilical blood pH; Apgar at 1 min and 5 min
Notes	Hypotension defined as a 20% drop in systolic blood pressure from baseline.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐generated
Allocation concealment (selection bias)	Unclear risk	Not stated
Blinding of participants and personnel (performance bias) All outcomes	High risk	Not blinded
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not blinded
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Not reported
Selective reporting (reporting bias)	Low risk	Most expected outcomes reported
Other bias	Low risk	Not apparent