{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T23:39:58Z","timestamp":1788219598260,"version":"build-2803163510"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>Post-spinal hypotension (PSH) is a common complication of neuraxial anaesthesia in high risk cesarean delivery (CD). This systematic review and network meta-analysis evaluate the comparative efficacy and safety of prophylactic intravenous infusions of norepinephrine, phenylephrine, and ephedrine to prevent PSH in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Randomised controlled trials comparing intravenous prophylactic norepinephrine, phenylephrine, and ephedrine in high risk CD and reporting maternal or fetal outcomes were considered. Two reviewers screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 tool. A frequentist network meta-analysis was carried out. Heterogeneity was inspected with I\u00b2 and Q statistics, and treatment ranking was estimated by\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      -scores. Sensitivity and subgroup analyses were performed to examine clinical modifiers such as preeclampsia and bolus versus infusion strategies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Eighteen trials involving 3331 participants were included. Administration of vasopressors reduced the incidence of PSH compared with placebo or no treatment [odds ratios (OR): 1.5; 95% confidence interval (CI) 1.12, 1.67; I\u00b2: 10.5%]. Norepinephrine and phenylephrine were superior to ephedrine. There was greater cardiac stability and less bradycardia and nausea with norepinephrine. In preeclamptic and in infusion treated patients, vasopressors were more effective, yet the advantage of norepinephrine was not consistently statistically significant. Neonatal outcomes such as APGAR scores and umbilical artery pH did not differ significantly between agents (OR: 1.1; 95% CI: 0.8, 1.5;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.15).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Both norepinephrine and phenylephrine are effective for the prevention of PSH in high-risk cesarean delivery receiving neuraxial anaesthesia, with norepinephrine offering more favourable maternal safety and tolerability. These findings justify the use of norepinephrine and phenylephrine over ephedrine in this patient population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ija.ija_1139_25","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T10:00:08Z","timestamp":1767348008000},"page":"102-114","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Prevention of post-spinal hypotension in high risk cesarean delivery: A systematic review and updated network meta-analysis of prophylactic vasopressor infusions"],"prefix":"10.4103","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7345-2856","authenticated-orcid":false,"given":"Arya","family":"Babul","sequence":"first","affiliation":[{"name":"Student, West Career and Technical Academy and President, Society for Awareness of Tropical Diseases, NV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3149-7556","authenticated-orcid":false,"given":"Sohi","family":"Ashraf","sequence":"additional","affiliation":[{"name":"Director, Critical Care Services, Mountain View Hospital, NV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5128-4997","authenticated-orcid":false,"given":"Leanne","family":"Free","sequence":"additional","affiliation":[{"name":"Assistant Professor and Residency Program Director, Department of Gynecologic Surgery and Obstetrics, Kirk Kerkorian School of Medicine at UNLV, NV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8868-9318","authenticated-orcid":false,"given":"Jyoti","family":"Desai","sequence":"additional","affiliation":[{"name":"Assistant Professor and Residency Associate Program Director, Department of Gynecologic Surgery and Obstetrics, Kirk Kerkorian School of Medicine at UNLV, NV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5017-3976","authenticated-orcid":false,"given":"Momina","family":"Hussain","sequence":"additional","affiliation":[{"name":"Scientific Officer, Genomics Department, Chinese Academy of Tropical Agriculture Sciences, Sanya, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7001-7187","authenticated-orcid":false,"given":"Tahira","family":"Rashid","sequence":"additional","affiliation":[{"name":"Resident Anaesthesiology, Department of Anaesthesiology, Fauji Foundation Hospital, Rawalpindi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5798-1892","authenticated-orcid":false,"given":"Najib","family":"Babul","sequence":"additional","affiliation":[{"name":"Chief Scientific Officer, Drug Development, Quadra Therapeutics, NV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"key":"R1-20260102","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.egja.2017.03.003","article-title":"Post-spinal anaesthesia hypotension during cesarean delivery, a review article","volume":"33","author":"Hasanin","year":"2017","journal-title":"Egypt J Anaesth"},{"key":"R2-20260102","doi-asserted-by":"crossref","first-page":"e451","DOI":"10.7861\/clinmed.2021-0508","article-title":"Severe hypertension in pregnancy","volume":"21","author":"Wiles","year":"2021","journal-title":"Clin Med (Lond)"},{"key":"R3-20260102","first-page":"CD002251","article-title":"Techniques for preventing hypotension during spinal anaesthesia for caesarean section. 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