Percentage of cases with systolic blood pressure <90mmHg for less than or equal to 5 (cumulative) minutes.
Neuraxial anesthesia is widely used for cesarean delivery and is associated with lower mortality and morbidity when compared to general anesthesia.5,8,10 Though overall morbidity is lower, neuraxial anesthesia can lead to maternal hypotension which has been cited as a common maternal complication during cesarean delivery.5-11 Hypotension can cause fetal acidosis and maternal nausea and vomiting.2,10,12 Prolonged hypotension can result in organ ischemia, uteroplacental hypoperfusion, loss of consciousness, and cardiovascular collapse.2,8 Techniques currently used to prevent hypotension related to spinal placement include intravenous fluid prehydration, vasopressor infusions, and less commonly physical methods such as leg elevation and compression stockings.2,5,8,10,11
In a Cochrane review of 126 studies including 9565 patients, 94 of the studies defined hypotension as a maternal systolic blood pressure below 80% of baseline recording, absolute value of less than 90 or 100 mmHg, or some combination thereof.2 Patients experiencing severe preeclampsia may be at lower risk of hypotension (but higher risk of other complications) as compared to healthy parturients.1 Nonetheless, hypotension and low placental perfusion remain a risk for the preeclamptic patient undergoing neuraxial anesthesia, necessitating the same level of vigilance as for non pre-eclamptic patients.3,7
Neuraxial placement to neonate delivery
All cesarean deliveries (as determined using the MPOG Obstetric Anesthesia Type phenotype) with neuraxial anesthesia only (as determined by the Anesthesia Technique-Neuraxial MPOG Phenotype.
SBP <90mmHg for less than or equal to 5 minutes during the time period of spinal placement to delivery.
Measure Start Time:
Measure End Time (limited to concepts between ‘anesthesia start’ and ‘anesthesia end’):
N/A
Not applicable- departmental measure only
Measure End Concepts
Measure Author | Institution |
Kate Buehler, RN |
University of Michigan |
Brooke Syzmanski-Bogart, RN |
University of Michigan |
Mark Dehring |
University of Michigan |
Nirav Shah, MD |
University of Michigan |
MPOG OB Subcommittee |
Date Reviewed | Reviewer | Institution | Summary | QC Vote |
---|---|---|---|---|
02/2021 |
TBD |
TBD |
First Review Due: 2024 |
NA |
Date | Criteria | Revision |
---|---|---|
06/10/2021 | Exclusion | Modified to exclude cesarean hysterectomy cases using Obstetric Anesthesia Type phenotype |