Efficacy and safety of norepinephrine versus phenylephrine for post-spinal hypotension in preeclamptic patients: A systematic review and meta-analysis
•Norepinephrine reduces maternal bradycardia versus phenylephrine.•Both vasopressors equally maintain blood pressure and neonatal outcomes.•No significant difference in umbilical blood gas between both vasopressors.•Larger trials are needed to confirm and guide clinical practice. We conducted a syst...
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| Veröffentlicht in: | European journal of obstetrics & gynecology and reproductive biology 2024-12, Vol.303, p.91-98 |
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| container_title | European journal of obstetrics & gynecology and reproductive biology |
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| creator | Ahmed, Shahzaib Ahmad, Eeman Fatima, Eeshal Akram, Umar Ur Rehman, Obaid Harikrishna, Arya Sharif, Shaiza Akmal, Noreen Nashwan, Abdulqadir J. |
| description | •Norepinephrine reduces maternal bradycardia versus phenylephrine.•Both vasopressors equally maintain blood pressure and neonatal outcomes.•No significant difference in umbilical blood gas between both vasopressors.•Larger trials are needed to confirm and guide clinical practice.
We conducted a systematic review and meta-analysis to evaluate the fetomaternal outcomes after the administration of norepinephrine or phenylephrine for the treatment of post spinal hypotension in preeclamptic women undergoing a cesarean section.
We searched on PubMed, Embase, Scopus, Cochrane CENTRAL, and clinicaltrials.gov from inception till June 2024.
Randomized controlled trials of preeclamptic women receiving norepinephrine or phenylephrine for post spinal hypotension were included.
Two reviewers extracted data onto an Excel spreadsheet. R version 4.4 was used for statistical analysis. Risk ratios (RR) and their 95% confidence intervals (CIs) were calculated and pooled using the random effects model. Cochrane’s risk of bias (RoB 2) tool was used for quality assessment. This review has been registered with PROSPERO (CRD42024532740).
A total of 4 trials, comprising 413 participants, were included in this review. 206 patients received norepinephrine, while 207 received phenylephrine. The incidence of maternal bradycardia was significantly lower in the norepinephrine group compared with the phenylephrine group (RR = 0.25, 95 % CI = 0.16 to 0.39, p |
| doi_str_mv | 10.1016/j.ejogrb.2024.10.012 |
| format | Article |
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We conducted a systematic review and meta-analysis to evaluate the fetomaternal outcomes after the administration of norepinephrine or phenylephrine for the treatment of post spinal hypotension in preeclamptic women undergoing a cesarean section.
We searched on PubMed, Embase, Scopus, Cochrane CENTRAL, and clinicaltrials.gov from inception till June 2024.
Randomized controlled trials of preeclamptic women receiving norepinephrine or phenylephrine for post spinal hypotension were included.
Two reviewers extracted data onto an Excel spreadsheet. R version 4.4 was used for statistical analysis. Risk ratios (RR) and their 95% confidence intervals (CIs) were calculated and pooled using the random effects model. Cochrane’s risk of bias (RoB 2) tool was used for quality assessment. This review has been registered with PROSPERO (CRD42024532740).
A total of 4 trials, comprising 413 participants, were included in this review. 206 patients received norepinephrine, while 207 received phenylephrine. The incidence of maternal bradycardia was significantly lower in the norepinephrine group compared with the phenylephrine group (RR = 0.25, 95 % CI = 0.16 to 0.39, p < 0.01). There were no statistical differences in other maternal outcomes or in the umbilical artery and umbilical vein blood gas analysis values. We also analyzed adverse events such as nausea (RR = 1.00, 95 % CI: 0.62 to 1.60, p = 1.00) and vomiting (RR = 0.99, 95 % CI: 0.89 to 1.11, p = 0.61), but they did not show a significant association with any group. All the trials had a moderate or low risk of bias.
Bolus doses of NE and PE for the treatment of post-spinal hypotension in preeclamptic women undergoing cesarean sections were found to exhibit comparable neonatal outcomes. However, NE provided superior maternal safety due to a lower incidence of bradycardia compared to PE.</description><identifier>ISSN: 0301-2115</identifier><identifier>ISSN: 1872-7654</identifier><identifier>EISSN: 1872-7654</identifier><identifier>DOI: 10.1016/j.ejogrb.2024.10.012</identifier><identifier>PMID: 39437476</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>Anesthesia, Spinal - adverse effects ; Cesarean Section - adverse effects ; Female ; Humans ; Hypotension ; Hypotension - drug therapy ; Norepinephrine ; Norepinephrine - administration & dosage ; Norepinephrine - adverse effects ; Norepinephrine - therapeutic use ; Phenylephrine ; Phenylephrine - administration & dosage ; Phenylephrine - adverse effects ; Phenylephrine - therapeutic use ; Pre-Eclampsia - drug therapy ; Preeclampsia ; Pregnancy ; Vasoconstrictor Agents - administration & dosage ; Vasoconstrictor Agents - adverse effects ; Vasoconstrictor Agents - therapeutic use</subject><ispartof>European journal of obstetrics & gynecology and reproductive biology, 2024-12, Vol.303, p.91-98</ispartof><rights>2024 The Author(s)</rights><rights>Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c287t-a34256912de7113b783886abdfacff1423bafb8c488ecf14d4f8d3f826e31cc53</cites><orcidid>0000-0001-9374-927X ; 0000-0003-4845-4119</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0301211524005505$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39437476$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ahmed, Shahzaib</creatorcontrib><creatorcontrib>Ahmad, Eeman</creatorcontrib><creatorcontrib>Fatima, Eeshal</creatorcontrib><creatorcontrib>Akram, Umar</creatorcontrib><creatorcontrib>Ur Rehman, Obaid</creatorcontrib><creatorcontrib>Harikrishna, Arya</creatorcontrib><creatorcontrib>Sharif, Shaiza</creatorcontrib><creatorcontrib>Akmal, Noreen</creatorcontrib><creatorcontrib>Nashwan, Abdulqadir J.</creatorcontrib><title>Efficacy and safety of norepinephrine versus phenylephrine for post-spinal hypotension in preeclamptic patients: A systematic review and meta-analysis</title><title>European journal of obstetrics & gynecology and reproductive biology</title><addtitle>Eur J Obstet Gynecol Reprod Biol</addtitle><description>•Norepinephrine reduces maternal bradycardia versus phenylephrine.•Both vasopressors equally maintain blood pressure and neonatal outcomes.•No significant difference in umbilical blood gas between both vasopressors.•Larger trials are needed to confirm and guide clinical practice.
We conducted a systematic review and meta-analysis to evaluate the fetomaternal outcomes after the administration of norepinephrine or phenylephrine for the treatment of post spinal hypotension in preeclamptic women undergoing a cesarean section.
We searched on PubMed, Embase, Scopus, Cochrane CENTRAL, and clinicaltrials.gov from inception till June 2024.
Randomized controlled trials of preeclamptic women receiving norepinephrine or phenylephrine for post spinal hypotension were included.
Two reviewers extracted data onto an Excel spreadsheet. R version 4.4 was used for statistical analysis. Risk ratios (RR) and their 95% confidence intervals (CIs) were calculated and pooled using the random effects model. Cochrane’s risk of bias (RoB 2) tool was used for quality assessment. This review has been registered with PROSPERO (CRD42024532740).
A total of 4 trials, comprising 413 participants, were included in this review. 206 patients received norepinephrine, while 207 received phenylephrine. The incidence of maternal bradycardia was significantly lower in the norepinephrine group compared with the phenylephrine group (RR = 0.25, 95 % CI = 0.16 to 0.39, p < 0.01). There were no statistical differences in other maternal outcomes or in the umbilical artery and umbilical vein blood gas analysis values. We also analyzed adverse events such as nausea (RR = 1.00, 95 % CI: 0.62 to 1.60, p = 1.00) and vomiting (RR = 0.99, 95 % CI: 0.89 to 1.11, p = 0.61), but they did not show a significant association with any group. All the trials had a moderate or low risk of bias.
Bolus doses of NE and PE for the treatment of post-spinal hypotension in preeclamptic women undergoing cesarean sections were found to exhibit comparable neonatal outcomes. However, NE provided superior maternal safety due to a lower incidence of bradycardia compared to PE.</description><subject>Anesthesia, Spinal - adverse effects</subject><subject>Cesarean Section - adverse effects</subject><subject>Female</subject><subject>Humans</subject><subject>Hypotension</subject><subject>Hypotension - drug therapy</subject><subject>Norepinephrine</subject><subject>Norepinephrine - administration & dosage</subject><subject>Norepinephrine - adverse effects</subject><subject>Norepinephrine - therapeutic use</subject><subject>Phenylephrine</subject><subject>Phenylephrine - administration & dosage</subject><subject>Phenylephrine - adverse effects</subject><subject>Phenylephrine - therapeutic use</subject><subject>Pre-Eclampsia - drug therapy</subject><subject>Preeclampsia</subject><subject>Pregnancy</subject><subject>Vasoconstrictor Agents - administration & dosage</subject><subject>Vasoconstrictor Agents - adverse effects</subject><subject>Vasoconstrictor Agents - therapeutic use</subject><issn>0301-2115</issn><issn>1872-7654</issn><issn>1872-7654</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9u1DAQxq0K1C6FN0DIRy5Z4j-beDkgVVVbkCpxgbPlOGPWq8Q2Hm9RXoTnrbfbcsQHW_Ppm_nk-RHynrVr1rLu034N-_grD2veclmldcv4GVkx1fOm7zbyFVm1omUNZ2xzQd4g7tt6hNiekwuxlaKXfbcif2-c89bYhZowUjQOykKjoyFmSD5A2uV60wfIeECadhCW6UV0MdMUsTRYnWaiuyXFAgF9DNQHmjKAncycirc0meIhFPxMryguWGA2RznDg4c_T9kzFNOYOmdBj2_Ja2cmhHfP7yX5eXvz4_prc__97tv11X1juepLY4Tkm27L-Ag9Y2LolVCqM8PojHWOSS4G4wZlpVJgaz1Kp0bhFO9AMGs34pJ8PM1NOf4-ABY9e7QwTSZAPKAWjG17zruOVas8WW2OiBmcTtnPJi-atfpIRO_1iYg-EjmqlUht-_CccBhmGP81vSCohi8nA9R_1m1kjbauysLoM9iix-j_n_AId2SjPw</recordid><startdate>202412</startdate><enddate>202412</enddate><creator>Ahmed, Shahzaib</creator><creator>Ahmad, Eeman</creator><creator>Fatima, Eeshal</creator><creator>Akram, Umar</creator><creator>Ur Rehman, Obaid</creator><creator>Harikrishna, Arya</creator><creator>Sharif, Shaiza</creator><creator>Akmal, Noreen</creator><creator>Nashwan, Abdulqadir J.</creator><general>Elsevier B.V</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9374-927X</orcidid><orcidid>https://orcid.org/0000-0003-4845-4119</orcidid></search><sort><creationdate>202412</creationdate><title>Efficacy and safety of norepinephrine versus phenylephrine for post-spinal hypotension in preeclamptic patients: A systematic review and meta-analysis</title><author>Ahmed, Shahzaib ; 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We conducted a systematic review and meta-analysis to evaluate the fetomaternal outcomes after the administration of norepinephrine or phenylephrine for the treatment of post spinal hypotension in preeclamptic women undergoing a cesarean section.
We searched on PubMed, Embase, Scopus, Cochrane CENTRAL, and clinicaltrials.gov from inception till June 2024.
Randomized controlled trials of preeclamptic women receiving norepinephrine or phenylephrine for post spinal hypotension were included.
Two reviewers extracted data onto an Excel spreadsheet. R version 4.4 was used for statistical analysis. Risk ratios (RR) and their 95% confidence intervals (CIs) were calculated and pooled using the random effects model. Cochrane’s risk of bias (RoB 2) tool was used for quality assessment. This review has been registered with PROSPERO (CRD42024532740).
A total of 4 trials, comprising 413 participants, were included in this review. 206 patients received norepinephrine, while 207 received phenylephrine. The incidence of maternal bradycardia was significantly lower in the norepinephrine group compared with the phenylephrine group (RR = 0.25, 95 % CI = 0.16 to 0.39, p < 0.01). There were no statistical differences in other maternal outcomes or in the umbilical artery and umbilical vein blood gas analysis values. We also analyzed adverse events such as nausea (RR = 1.00, 95 % CI: 0.62 to 1.60, p = 1.00) and vomiting (RR = 0.99, 95 % CI: 0.89 to 1.11, p = 0.61), but they did not show a significant association with any group. All the trials had a moderate or low risk of bias.
Bolus doses of NE and PE for the treatment of post-spinal hypotension in preeclamptic women undergoing cesarean sections were found to exhibit comparable neonatal outcomes. However, NE provided superior maternal safety due to a lower incidence of bradycardia compared to PE.</abstract><cop>Ireland</cop><pub>Elsevier B.V</pub><pmid>39437476</pmid><doi>10.1016/j.ejogrb.2024.10.012</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-9374-927X</orcidid><orcidid>https://orcid.org/0000-0003-4845-4119</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0301-2115 |
| ispartof | European journal of obstetrics & gynecology and reproductive biology, 2024-12, Vol.303, p.91-98 |
| issn | 0301-2115 1872-7654 1872-7654 |
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| subjects | Anesthesia, Spinal - adverse effects Cesarean Section - adverse effects Female Humans Hypotension Hypotension - drug therapy Norepinephrine Norepinephrine - administration & dosage Norepinephrine - adverse effects Norepinephrine - therapeutic use Phenylephrine Phenylephrine - administration & dosage Phenylephrine - adverse effects Phenylephrine - therapeutic use Pre-Eclampsia - drug therapy Preeclampsia Pregnancy Vasoconstrictor Agents - administration & dosage Vasoconstrictor Agents - adverse effects Vasoconstrictor Agents - therapeutic use |
| title | Efficacy and safety of norepinephrine versus phenylephrine for post-spinal hypotension in preeclamptic patients: A systematic review and meta-analysis |
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