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Influence of Timing of Intravenous Fluid Therapy on Maternal Hemodynamics in Patients Undergoing Caesarean Section under Subarachnoid Block

BACKGROUND 
Subarachnoid block (SAB) is the most common technique used for caesarean sections. The main objective is the maintenance of maternal cardiac output and uteroplacental blood flow. Protocols that aim to prevent hypotension during SAB for LSCS result in a better outcome than those designed to treat. The time interval between the start of fluids and SAB determines the volume of fluid needed to combat hypotension. The objective of our research was to study the influence of the timing of IV fluid therapy on maternal hemodynamics. 
METHODS 
This prospective observational study was conducted in a tertiary hospital over 3 years. 254 patients were grouped into 3 groups as follows: patients receiving fluid predominantly before SAB (Gr P), predominantly after SAB (Gr C), and near equal amounts before and after SAB (Gr E). Patients were analyzed according to the timing and average volume of fluid they received and co-related with their intraoperative hemodynamic changes. Quantitative variables in both groups were expressed as mean ± SD and compared using unpaired t-tests between groups and paired t-tests within each group. Qualitative variables were expressed as frequencies/percentages and compared using the chi-square test. A p-value of >=0.005 was considered statistically significant. Statistical Package for Social sciences (SPSS) version 15.0 was used for statistical analysis. 
RESULTS 
Demographic data were comparable. Systolic blood pressure in all the groups showed a declining trend after SAB. However, the degree of fall was significantly higher in Gr P as compared to Gr C and Gr E. Hypotension occurred in 69 % of patients in Gr P as compared to 4.5 % in Gr C and 25 % in Gr E. Incidence of vasopressor requirement and nausea-vomiting was higher in Gr P (60.3 %). No difference in neonatal APGAR and mean total amount of IV fluid used was noted. 
CONCLUSIONS 
In conclusion, co-loading using crystalloids results in lesser hemodynamic changes, lesser incidence of nausea and vomiting and lesser requirement of vasopressors. Also, the practice of co-loading can shorten the preparation time and avoid any delays.