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To address this, we aimed to synthesise current evidence from randomised controlled trials comparing vasopressor infusions for various feto\u2010maternal outcomes in normotensive adult patients undergoing caesarean delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Randomised controlled trials evaluating maternal and fetal outcomes associated with prophylactic vasopressor infusion were identified through comprehensive database searches. Primary outcomes were the incidence of maternal hypotension and umbilical artery base excess. Secondary outcomes comprised maternal and fetal parameters including: umbilical artery and vein pH; umbilical vein base excess; Apgar scores at 1\u2009min and 5\u2009min; and incidence of maternal intra\u2010operative nausea and vomiting, bradycardia, tachycardia and hypertension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fifty\u2010five trials involving 5487 patients undergoing caesarean delivery under spinal or combined spinal and epidural anaesthesia using a variety of vasopressor infusions were included in the final analysis. Four drugs\u2014metaraminol, noradrenaline, phenylephrine and adrenaline\u2014were judged to be \u2018definitely superior\u2019 to control (no active vasopressor infusion) for the prevention of hypotension. Umbilical vessel analyses indicated that mephentermine and metaraminol provided superior preservation of both umbilical arterial and venous acid\u2013base balance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Current evidence suggests that continuous infusions of \u03b1\u2010agonists with mild \u03b2\u2010activity (e.g. noradrenaline, metaraminol) are preferable to mixed adrenergic agonists such as ephedrine for preventing maternal hypotension. While these findings reinforce existing recommendations for maternal haemodynamic management, the evidence base for fetal outcomes remains limited.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/anae.70204","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T09:59:39Z","timestamp":1773914379000},"page":"995-1007","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Efficacy and safety of different vasopressor infusions on feto\u2010maternal outcomes in normotensive patients undergoing caesarean delivery: a systematic review and network meta\u2010analysis of randomised controlled trials"],"prefix":"10.1111","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1538-8728","authenticated-orcid":false,"given":"Narinder Pal","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Pain Medicine The Ottawa Hospital, University of 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