{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T19:54:04Z","timestamp":1791834844300,"version":"4.3.4"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Recommended prophylaxis against postspinal hypotension includes vasopressor infusions needing continuous and accurate titration preferably with infusion pumps, along with close blood pressure monitoring. In resource constrained settings with high volume obstetric care such intensive management may be difficult for every patient. Thus a dependent, simple tool without need of advanced technology to predict postspinal hypotension is desirable. Although PRAM score is such a tool it has never been validated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>To validate previously formulated bed-side PRAM score (also after adding postspinal tachycardia as a variable) for predicting postspinal hypotension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>This prospective study included 371 consenting patients scheduled for elective\/emergency cesarean delivery using standardized spinal block. Postspinal hypotension was defined as systolic blood pressure &lt;80% of baseline or &lt;90mmHg, whichever was higher (upto 15 minutes after baby delivery); and managed with boluses of phenylephrine (50 \u03bcg i.v.) till resolution. PRAM score included grade of 1 for each of: baseline heart rate &gt;90 bpm, mean arterial pressure &lt;90 mmHg and age &gt;25 years minutes. Postspinal tachycardia was an increase in heart rate by &gt;10 bpm within 5 minutes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Incidence of postspinal hypotension was 49.3%, with median onset time of 3 minutes, number of hypotensive episodes ranging from 0 to 5, and amount of phenylephrine required 50-300 \u03bcg. ROC analysis showed significant predictive value of PRAM score for postspinal hypotension, with an AUC of 0.578 [95% CI: 0.520-0.636] (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.008); and sensitivity of 89% at cut-off value of PRAM score= 1. When including tachycardia within the first 5 minutes post-block, modified PRAM score had improved predictive accuracy with AUC of 0.601 [95% CI: 0.544-0.659] (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The PRAM score effectively predicts postspinal hypotension during cesarean delivery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/sja.sja_138_25","type":"journal-article","created":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T12:01:18Z","timestamp":1756900878000},"page":"553-558","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["External validation of PRAM score for predicting post spinal hypotension during cesarean delivery: A prospective observational study"],"prefix":"10.4103","volume":"19","author":[{"given":"Prashansa","family":"Dayal","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asha","family":"Tyagi","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surbhi","family":"Tyagi","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Thamburu","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashmi","family":"Salhotra","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"key":"R1-20260421","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1213\/ANE.0000000000001204","article-title":"Obstetric anesthesia workforce survey: A 30-year update","volume":"122","author":"Traynor","year":"2016","journal-title":"Anesth Analg"},{"key":"R2-20260421","doi-asserted-by":"crossref","first-page":"1914","DOI":"10.1213\/ANE.0000000000001677","article-title":"Choice of anesthesia for cesarean delivery: An analysis of the national anesthesia clinical outcomes registry","volume":"124","author":"Juang","year":"2017","journal-title":"Anesth Analg"},{"key":"R3-20260421","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1111\/anae.14080","article-title":"International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia","volume":"73","author":"Kinsella","year":"2018","journal-title":"Anaesthesia"},{"key":"R4-20260421","first-page":"CD004350","article-title":"Regional versus general anaesthesia for caesarean section","volume":"10","author":"Afolabi","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"R6-20260421","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.7196\/SAMJ.2017.v107i12.12390","article-title":"Obstetric spinal hypotension: Preoperative risk factors and the development of a preliminary risk score-the PRAM score","volume":"107","author":"Bishop","year":"2017","journal-title":"S Afr Med J"},{"key":"R7-20260421","first-page":"170","article-title":"Predicting spinal hypotension during Caesarean section","volume":"20","author":"Bishop","year":"2014","journal-title":"S Afr Med J"},{"key":"R8-20260421","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/S0959-289X(96)80067-7","article-title":"Advance prediction of hypotension at cesarean delivery under spinal anesthesia","volume":"5","author":"Kinsella","year":"1996","journal-title":"Int J Obstet Anesth"},{"key":"R9-20260421","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/anae.14063","article-title":"Can point\u2010of\u2010care ultrasound predict spinal hypotension during caesarean section? 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