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2026 SOAP Annual Meeting
April 29 - May 3, 2026 | Montreal, Quebec Canada
2335277
Feasibility of Maintaining Maternal Systolic Blood Pressure =90% Baseline During Elective Cesarean Delivery Under Spinal Anesthesia and Association with Neonatal Outcomes: A Retrospective Cohort Study
Poster Presenter
Authors
Anna Wilkinson, Sabina Dobrer, Kaitlin Nelson, Elise Hindle, Juliana Kruthof
Affiliations
Part of Topic
Cesarean Delivery and other Surgery
Background: SOAP ERAC recommends maintaining maternal BP at baseline and routine use of prophylactic phenylephrine infusion1. NICE guidelines emphasize maintenance of maternal SBP ≥90% of baseline and avoid severe hypotension (SBP <80% baseline)2. Maternal hypotension has been associated with negative neonatal outcomes. A recent UK multi-centre audit reported SBP ≥90% of baseline in only 9.1% of cases despite routine vasopressor use3.
Objective: Assess adherence to NICE guidelines (SBP ≥90% baseline) at our institution. Hypothesis: Guideline adherence (SBP ≥90% baseline) will be achieved in a minority of elective cesarean deliveries under neuraxial anesthesia.
Study Design: Single center retrospective cohort study. Chart review from Mar 2022 - Jan 2023. ASA II-III patients (≥37/40 gestation). Elective CD under spinal or combined spinal-epidural. Exclusion: Conversion to GA, multiple gestation, fetal abnormality, maternal cardiac disease or dysautonomia, hypertensive disorders of pregnancy, major hemorrhage or incomplete data. Primary outcome: Percentage of cases with 100% guideline adherence, defined as maintenance of SBP ≥90% of baseline from spinal initiation to baby delivery. Secondary outcomes: Incidence of severe hypotension (SBP <80% of baseline). Neonatal outcomes including Apgar scores, arterial gases (pH, base excess), fetal acidemia (pH <7.20) and unanticipated NICU admission.
Results: Total of 498 cases met inclusion criteria and were analyzed. Only 37% of cases met NICE Guideline recommendations (Fig.1 ). Severe hypotension (SBP <80% baseline) was observed in 68% of cases. In 0.6% (3 cases) no SBP values were ≥90% baseline. SBP showed the most variability closer to time of baby delivery (Fig.2). Vasopressor use: By 1 minute after neuraxial anesthesia, 84.1% of cases had started a vasopressor infusion, and by 3 minutes, 93.9% had. Higher BMI was associated with a lower likelihood of maintaining stable blood pressure (OR=0.93, 95% CI:0.92–0.95, p<0.001). Higher baseline SBP was associated with a lower likelihood of staying close to baseline (OR=0.95, 95% CI:0.94–0.95, p<0.001). Neonatal outcomes were similar between cases with and without severe hypotension; arterial pH 7.25 vs 7.26, 1min Apgar 8.66 vs 8.67, 5 min Apgar 8.97 vs 8.87, 3 NICU admissions.
Discussion: Guideline adherence was low but better than similar studies. Baseline SBP value selection may play an important role. No observed difference in neonatal outcomes. Greatest variability close to time of delivery. Higher initial SBP groups with higher instability – borderline hypertensive disease. Higher BMI with more instability – greater spread of neuraxial. Limitations: Rates of intraoperative nausea and vomiting were not routinely recorded. Level of block testing was not recorded. Future work: Larger sample for better correlation of SBP subgroups with neonatal outcomes. Local departmental vasopressor administration: Comparison of norepinephrine and phenylephrine