Comparison of crystalloid preloading and co-loading for the prevention of spinal induced-hypotension in elective cesarean delivery: a prospective cohort study

Background: Maternal hypotension is the most frequent complication of spinal anesthesia for cesarean delivery. In this study, we assessed the effect of crystalloid preloading versus co-loading on the incidence of spinal anesthesia-induced hypotension in parturients undergoing elective cesarean delivery. Method: An institutional-based prospective cohort study was conducted. A total of 90 participants were divided into three groups: 30 participants in preload group (G1) given 1000 ml of normal saline 15 minutes before spinal anesthesia, 30 participants in co-load group (G2) given 1000 ml of normal saline fluid within 15 minutes together with spinal anesthesia, and 30 participants in the control group (G3) who were not given preloading or co-loading fluids. Statistical analysis for the differences among the three groups was analyzed using a repeated measure multivariate analysis of variance (MANOVA) test. The Bonferonni post hoc test was used to compare the differences between the groups. Result: In the current study, systolic blood pressure, diastolic blood pressure, and mean arterial pressure significantly decreased among the control groups compared with the co-load and preload groups, P < 0.05. Vasopressor requirements were significantly decreased in the co-load group compared with preload and control groups, ( P = 0.043). The incidence of nausea and vomiting was also higher among control groups, ( P = 0.031). Conclusion: Based on the results of the current study, crystalloid fluid co-loading is more effective in reducing the incidence of hypotension after spinal anesthesia, reducing the need for a vasopressor and the occurrence of nausea and vomiting after spinal anesthesia in cesarean section parturients compared with preloading crystalloid fluid.