الفهرس 
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Abstract
Cesarean delivery is a surgical intervention to save the lives of the mother and the baby
in situations where vaginal delivery is impossible or dangerous. In general, cesarean birth is
carried out utilizing regional anesthesia approaches, with spinal anesthesia being the primary
option. Spinal anesthesia is now regarded as the standard for cesarean delivery, but
unfortunately, it is frequently associated with bradycardia and hypotension. Spinal
hypotension can occur precipitously and, if severe, can lead to significant perinatal
complications. So, prevention of post spinal hypotension is critical in cesarean section for a
successful maternal and fetal outcome.
Current national guidelines prioritize non-pharmacological approaches to prevent
physiological changes in cesarean women following spinal anesthesia. Leg compression
therapy is a non-pharmacological technique that can be used to maintain women’s
physiological parameters during cesarean section. It has been found that leg compression with
elastic stocking can effectively decrease the occurrence of post spinal hypotension in women
undergoing CS. Additionally, leg compression has been associated with higher neonatal
Apgar scores.
This study aimed to:
Determine the effect of lower leg compression application during cesarean section on
women’s physiological parameters and neonatal outcome.
To fulfill the study aim: A nonrandomized controlled clinical trial was followed.
Materials and method
Setting:
The study was carried out in the cesarean delivery room of Damanhour educational
hospital, which is affiliated to the Ministry of Health in Elbehira governorate, Egypt. This
hospital was particularly chosen because it is a major hospital that serves Damanhour city and
the surrounding areas. Also, the turnover was satisfactory for the study.
Subjects:
A convenient sample of 100 women was selected from the previously mentioned
setting. The selected subjects who fulfilled the inclusion criteria were assigned to one of two
groups (study and control).
A Pilot study:
After the development of the tools, a pilot study was conducted on 10 women who were
excluded from the main study sample. The pilot study revealed that the tools were clear,
relevant and applicable.
Tools used in this study:
Three tools were used for data collection, tool I: Socio-demographic, general and
reproductive history interview schedule, tool II: Maternal physiological parameters and
related signs assessment sheet and tool III: Neonatal outcome assessment sheet.
Data collection consumed a period of six months started from the beginning of July
2022 till the end of December 2022.
The researcher interviewed each woman individually for 10-15 min before cesarean
section in the waiting area to collect data of tool I.
The study subjects were divided into two groups 50 study and 50 control.
All of the ordinary preoperative care was administrated to women of both groups.
The mother’s base line physiological parameters including: heart rate, respiration, means
arterial pressure and peripheral oxygenation were recorded immediately before skin
incision.
The control group: included 50 women who received the ordinary pre-operative care
without the application of the elastic stocking.
For the study group: compromised 50 women. A long elastic stocking (ordinary
pressure 20-30 mmHg) with different sizes (medium, large, and x-large) was applied
before spinal anesthesia till the end of the cesarean birth and was removed prior the
woman’s discharge from the operating room.
For both groups, the physiological parameters including: heart rate, respiration, mean
arterial pressure and peripheral oxygenation were recorded intra operatively every five
min following spinal anesthesia until the end of the cesarean section.
For newborns of the two groups, Apgar scores were additionally assessed immediately
after delivery of the baby at the 1st and 5th minute.
The main findings of the present study were:
1. Subject’s general characteristics.
- There was no statistically significant difference among both groups concerning sociodemographic
characteristics, general and reproductive history.
2. Baseline physiological parameters.
- No statistically significant difference was observed in both groups concerning the
mother’s base line physiological parameters including: heart rate, respiration, means
arterial pressure and peripheral oxygenation.
3. Maternal physiological parameters.
Heart rate (HR) change after spinal anesthesia
- There was highly statistically significant difference between the study and control
groups regarding heart rate from 5 min to 40 min. On the other hand, no statistically
significant difference was observed between the study and control groups from 45 min
to 60 min, where p= (0.413, 0.694, 0.139, 0.053) respectively.
Respiration change after spinal anesthesia
- There was no statistically significant difference among both groups regarding
respiration except at 45min, where there was highly statistically significant difference
among two groups where p= 0.014.
Systolic BP change after spinal anesthesia
- Highly statistically significant difference was observed between the study and control
groups in relation to systolic BP from 5 min to 25min, where p= (0.046, <0.001, 0.038,
0.015, 0.045) respectively.
Diastolic BP change after spinal anesthesia
- Highly statistically significant difference was observed between the study and control
groups regarding diastolic BP from 5 min to 35min.
Mean arterial pressure change after spinal anesthesia
- Also, highly statistically significant difference was observed between the study and
control groups considering mean arterial pressure from 5 min to 35min.
Peripheral oxygenation change after spinal anesthesia
- Highly statistically significant difference was observed between the study and control
groups concerning peripheral oxygenation at 5min, 40 min and 45min, where p= (0.029,
0.001, <0.001) respectively.
4. Incidence of hypotension.
- Less than one-fifth (14%) of the study group had hypotension, compared to more than
one-half (58%) of the control group. Accordingly, highly statistically significant
difference was observed between the study and control groups.
5. Maternal related signs of hypotension.
- Highly statistically significant difference was observed among the two groups in relation to
nausea, vomiting and shivering, where p= (0.015, 0.038, 0.037). On the other hand, no
statistically significant difference was found between the study and control groups
concerning blurred vision, confusion and dizziness, where p= (0.161, 0.779, 1.000).
6. Neonatal outcome.
- The mean APGAR score in 1st minute & APGAR score in 5th minute was higher
between study group compared to control group. Moreover, none of babies of the study
group need for resuscitation, while 4% of the control group had resuscitation. On the
other hand, more than one-quarter (26%) of the babies of the study group admitted to
intensive care unit compared to one-half (50%) of the control group. A highly
statistically significant difference was observed between the both groups in relation to
oxygen saturation, APGAR score at 1st minute, APGAR score at 5th minute and
admission to intensive care.
7. Relation between incidence of hypotension and neonatal outcome.
- Highly statistically significant difference was observed in the control group concerning
the incidence of hypotension and APGAR at 1st minute, where p= (0.045). In this
regard, more than three-fifths ( Systolic BP change after spinal anesthesia
- Highly statistically significant difference was observed between the study and control
groups in relation to systolic BP from 5 min to 25min, where p= (0.046, <0.001, 0.038,
0.015, 0.045) respectively.
Diastolic BP change after spinal anesthesia
- Highly statistically significant difference was observed between the study and control
groups regarding diastolic BP from 5 min to 35min.
Mean arterial pressure change after spinal anesthesia
- Also, highly statistically significant difference was observed between the study and
control groups considering mean arterial pressure from 5 min to 35min.
Peripheral oxygenation change after spinal anesthesia
- Highly statistically significant difference was observed between the study and control
groups concerning peripheral oxygenation at 5min, 40 min and 45min, where p= (0.029,
0.001, <0.001) respectively.
4. Incidence of hypotension.
- Less than one-fifth (14%) of the study group had hypotension, compared to more than
one-half (58%) of the control group. Accordingly, highly statistically significant
difference was observed between the study and control groups.
5. Maternal related signs of hypotension.
- Highly statistically significant difference was observed among the two groups in relation to
nausea, vomiting and shivering, where p= (0.015, 0.038, 0.037). On the other hand, no
statistically significant difference was found between the study and control groups
concerning blurred vision, confusion and dizziness, where p= (0.161, 0.779, 1.000).
6. Neonatal outcome.
- The mean APGAR score in 1st minute & APGAR score in 5th minute was higher
between study group compared to control group. Moreover, none of babies of the study
group need for resuscitation, while 4% of the control group had resuscitation. On the
other hand, more than one-quarter (26%) of the babies of the study group admitted to
intensive care unit compared to one-half (50%) of the control group. A highly
statistically significant difference was observed between the both groups in relation to
oxygen saturation, APGAR score at 1st minute, APGAR score at 5th minute and
admission to intensive care.
7. Relation between incidence of hypotension and neonatal outcome.
- Highly statistically significant difference was observed in the control group concerning
the incidence of hypotension and APGAR at 1st minute, where p= (0.045). In this
regard, more than three-fifths ((62.1 %) of the women who experienced hypotension had moderate risk APGAR score.
Recommendations:
Based on the present study findings, the following are suggested:
Leg compression must be employed as a crucial component of perioperative care and
can be complemented with booklets and brochures.
Lower leg compression application throughout CS should be considered in policies and
regulations of maternal hospital for improving women’s physiological parameters and
neonatal outcome.
Mother classes should be conducted in antenatal settings and outpatient clinics to
address the care that should be given to women underwent CS and potential
complications.
Recommended future studies:
Further studies are recommended to identify the impact of other lower leg compression
techniques throughout cesarean section on women’s physiological parameters and
neonatal outcome.
Non-pharmacological prophylactic approaches for management of post spinal
hypotension throughout cesarean delivery.
Further research about impact of applying lower leg compression on neonatal
hemodynamic indicators.