Issn Print: 0265-0215

Publication Date: 2010/06/12


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Table tilt for caesarean section - An audit: 11AP2–8

M. Haldar

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Background and Goal of Study: Maternal cardiovascular compromise and foetal distress in the supine position are well recognised.The systematic use of lateral table tilt or pelvic tilt is in practice since 1970s1. NICE recommends 15 degrees left lateral tilt for all pregnant women undergoing Caesarean sections2. Aim of the study was to compare the visually estimated tilt and the true measured tilt and the maternal and foetal outcome.
Materials and Methods: A prospective audit was carried out over a period of three months.43 parturients had singleton pregnancies and were undergoing elective or emergency LSCS. Table was tilted by the anaesthetists after the administration of the anaesthetic. Tilt was measured by the author with Inogon angle indicator and corrected to15 degree where necessary. Tilt was changed to neutral once baby was born.Type of anaesthetic, booking BMI,visual tilt,measured tilt,maternal hemodynamics,Apgar score and umbilical artery pH were recorded.
Results and Discussion: 40 patients had spinal or epidural and 2 had GA. All anaesthetists had knowledge of 15 degree tilt for Caesarean section. Visually guess was grossly inaccurate in 42/43. Average tilt given was only 8.09 degrees.Maternal hemodynamics were maintained within normal limits with fluids and metarominol boluses.Apgar from 8–10 and cord pH from7.1 to 7.5 were found.
Conclusion(s): Visual estimated angle were much less than 15 degree in most of the patients and may lead to aortocaval compression. Women felt insecure when table tilted to 15 degree especially in women with BMI> 35.Supports should be inserted to prevent inadvertent fall of the mother. Increasing the left lateral tilt and/ or manual uterine displacement can treat hypotension promptly. Table tilt should be measured routinely during Caesarean section.
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