{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T17:42:23Z","timestamp":1790876543439,"version":"4.1.0"},"reference-count":46,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"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":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>Phenylephrine is widely used to manage postspinal hypotension during cesarean delivery under neuraxial anesthesia. However, the optimal method of administration, bolus or infusion, remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods:<\/jats:title>\n                    <jats:p>\n                      This systematic review and meta-analysis (PROSPERO CRD420251081996) included randomized controlled trials comparing phenylephrine bolus and infusion regimens during cesarean delivery. The primary outcome was maternal hypotension. Secondary outcomes included reactive hypertension, bradycardia, intraoperative nausea and vomiting, and neonatal outcomes such as Apgar scores, umbilical arterial pH, and paO\n                      <jats:sub>2<\/jats:sub>\n                      . A random-effects model was used for meta-analysis, and trial sequential analysis (TSA) was performed to evaluate the robustness of the evidence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Twenty randomized controlled trials involving 2742 parturients (bolus n = 1314; infusion n = 1428) were included. Overall, there was no significant difference in predelivery hypotension between infusion and bolus regimens (RR 0.95, 95% CI 0.70\u20131.30; I\u00b2 =94%). However, in a subgroup of fixed-rate infusions, a reduction in hypotension was observed compared with bolus (RR 0.73; 95% CI 0.61\u20130.88). Infusion was associated with a higher risk of reactive hypertension, while bradycardia and other maternal outcomes were similar. Although Apgar scores and UA pH showed minor statistical differences, all neonatal values remained within normal clinical ranges. TSA confirmed sufficient evidence only for the fixed-rate infusion subgroup; the overall pooled estimate remained inconclusive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Phenylephrine infusion, particularly fixed-rate prophylactic infusion, may reduce hypotension, but the overall evidence does not demonstrate superiority over bolus dosing. Given the very high heterogeneity and increased reactive hypertension with infusion, results should be interpreted cautiously. Neonatal outcomes were clinically comparable between groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/joacp.joacp_489_25","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T12:00:29Z","timestamp":1774440029000},"page":"187-201","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Maternal and fetal outcomes of phenylephrine bolus versus infusion during cesarean delivery: A systematic review, meta-analysis, and trial sequential analysis"],"prefix":"10.4103","volume":"42","author":[{"given":"Arya","family":"Babul","sequence":"first","affiliation":[{"name":"Department of Tropical Diseases, West Career and Technical Academy and Society for Awareness of Tropical Diseases, NV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sohi","family":"Ashraf","sequence":"additional","affiliation":[{"name":"Intensive Care, MountainView Hospital, NV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyoti","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Surgery and Obstetrics, Kirk Kerkorian School of Medicine at UNLV, NV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leanne","family":"Free","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Surgery and Obstetrics, Kirk Kerkorian School of Medicine at UNLV, NV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Momina","family":"Hussain","sequence":"additional","affiliation":[{"name":"Genomics Department, Chinese Academy of Tropical Agriculture Sciences, Sanya, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najib","family":"Babul","sequence":"additional","affiliation":[{"name":"Drug Development, Quadra Therapeutics, NV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"R4-20260325","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1213\/ANE.0b013e31826ac3db","article-title":"Phenylephrine infusion versus bolus regimens during cesarean delivery under spinal anesthesia:A double-blind randomized clinical trial to assess hemodynamic changes","volume":"115","author":"Doherty","year":"2012","journal-title":"Anesth Analg"},{"key":"R5-20260325","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1186\/s40001-025-02564-w","article-title":"Diagnosis and management of paroxysmal sympathetic hyperactivity:A narrative review of recent literature","volume":"30","author":"Yin","year":"2025","journal-title":"Eur J Med Res"},{"key":"R6-20260325","doi-asserted-by":"crossref","first-page":"39","DOI":"10.2147\/LRA.S240753","article-title":"Control of spinal anesthesia-induced hypotension in adults","volume":"13","author":"Ferr\u00e9","year":"2020","journal-title":"Local Reg Anesth"},{"key":"R7-20260325","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.bpa.2017.01.001","article-title":"Spinal-induced hypotension:Incidence, mechanisms, prophylaxis, and management:Summarizing 20 years of research","volume":"31","author":"Lee","year":"2017","journal-title":"Best Pract Res Clin Anaesthesiol"},{"key":"R8-20260325","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1186\/s12871-024-02728-x","article-title":"Insights into obstetric anesthesia practices:A quantitative survey among physicians across Arab countries","volume":"24","author":"Nafeh","year":"2024","journal-title":"BMC Anesthesiol"},{"key":"R9-20260325","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1213\/ANE.0000000000007156","article-title":"Comparison of phenylephrine bolus and infusion regimens on maternal and fetal outcomes during cesarean delivery:A systematic review and meta-analysis","volume":"139","author":"Garg","year":"2024","journal-title":"Anesth Analg"},{"key":"R10-20260325","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1111\/anae.12445","article-title":"Prophylactic phenylephrine for caesarean section under spinal anaesthesia:Systematic review and meta-analysis","volume":"69","author":"Heesen","year":"2014","journal-title":"Anaesthesia"},{"key":"R11-20260325","first-page":"1","article-title":"PRISMA 2020 explanation and elaboration:Updated guidance and exemplars for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"R12-20260325","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1097\/01.NAJ.0000451683.66447.89","article-title":"Data extraction and synthesis:The steps following study selection in a systematic review","volume":"114","author":"Munn","year":"2014","journal-title":"Am J Nurs"},{"key":"R14-20260325","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.jclinepi.2018.01.013","article-title":"GRADE guidelines:19. 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