Lack of benefits of left tilt in emergent cesarean sections: a randomized study of cardiotocography, cord acid-base status and other parameters of the mother and the fetus

Abstract

Objective: To assess the benefits of performing the cesarean section in lateral tilt during active labor.

Setting: University Hospital.

Patients: 204 unselected women undergoing cesarean section (21.1% fetal distress, 45.6% cephalo-pelvic disproportion, 26.0% induction failure, 7.4% abnormal presentation) under general (86.8%) or spinal anesthesia (13.2%).

Design: Randomized study.

Intervention: During anesthesia induction and cesarean section 103 women were in partial left lateralization (20 degrees), whereas the remaining 101 remained in the supine position.

Main outcome measures: Internal cardiotocography during cesarean section. Umbilical artery acid-base analysis. Newborn evaluation. Maternal hemodynamic parameters.

Results: Fetal heart rate during cesarean section was similar in both groups, except for a baseline heart rate which was slightly higher in the lateral tilt group (137.5 +/- 19.2 vs 131.1 +/- 20). The umbilical artery pH values, as well as pCO2, base deficit, CO3H and oxygen saturation were similar in both groups. The pO2 value was significantly lower in the lateral tilt group (14.03 +/- 6.04 Hg mm vs 16.02 +/- 7.65). Newborn evaluation was similar in both groups. The blood pressure and heart rate of the mother during the cesarean section were also similar in both groups.

Conclusions: No benefits were found in performing cesarean section in left lateral tilt.