Abstract
Background: Spinal-induced hypotension is the most common complication following spinal anesthesia for cesarean section, posing risks to both maternal and neonatal wellbeing. Intravenous fluid preloading is a widely employed preventive strategy, yet the comparative efficacy of crystalloids versus colloids remains debated, particularly in resource-limited settings.
Objective: To compare the hemodynamic effects, vasopressor requirements, maternal side effects, and neonatal outcomes of crystalloid versus colloid preloading in patients undergoing elective cesarean section under spinal anesthesia.
Methods: A prospective observational study was conducted at POF Hospital Wah Cantt and HIT Hospital Taxila over four months. A total of 110 parturient of ASA physical status I–II undergoing elective cesarean sections were enrolled and divided into two groups: Group A (Crystalloid preload, n=55) receiving Ringer's Lactate 500–1000 mL or Normal Saline, and Group B (Colloid preload, n=55) receiving Haemaccel or Dextran 500 mL. Spinal anesthesia was administered with Bupivacaine 0.5% (10–12.5 mg). Hemodynamic parameters, vasopressor requirements, maternal side effects, and neonatal Apgar scores were recorded. Data were analyzed using SPSS v21 and Microsoft Excel 2024, employing independent samples t-tests, Chi-square tests, and descriptive statistics.
Results: The groups were comparable at baseline (p>0.05). Fluid type was significantly associated with intraoperative hypotension (t = −3.975, p < 0.001), with crystalloid recipients demonstrating lower intraoperative systolic blood pressure ranges (86–100 mmHg) compared to colloid recipients (101–110 mmHg). The timing of fluid administration also significantly influenced hypotension incidence (χ² = 17.526, df=4, p = 0.002). Phenylephrine was required in 54.5% of the crystalloid group versus only 18.2% of the colloid group (χ² = 15.714, p < 0.001). Side effect profiles differed significantly between groups (χ² = 10.862, p = 0.028): nausea predominated with crystalloids, while vomiting and bradycardia were more frequent with colloids. Neonatal Apgar scores were comparable across all fluid types (χ² = 14.135, df=12, p = 0.292), with the majority scoring 8–10.
Conclusion: Colloid preloading provides significantly superior hemodynamic stability and reduces vasopressor requirements compared to crystalloid preloading in parturient undergoing spinal anesthesia for elective cesarean sections, with comparable neonatal safety. These findings support the preferential use of colloids in patients at hemodynamic risk.