Purpose of review: To guide the optimal fluid management during cesarean delivery. The article focuses on fluid management to prevent hypotension during cesarean delivery performed under spinal anesthesia and excludes obstetric hemorrhage.
Recent findings: The literature underlines that crystalloid preloading is ineffective or poorly effective to prevent spinal hypotension during cesarean delivery. Crystalloid coloading is better but the effectiveness reported is variable and may depend on the volume used and the speed of administration at onset of sympathetic blockade. Hydroxyethyl starch (HES) preloading is more consistently effective in reducing the incidence and severity of hypotension. HES coloading appears as effective as HES preloading. Because none of these fluid-loading methods is completely effective at preventing hypotension, some sort of prophylactic vasopressor regimen should always be added. Routine fluid loading is no longer advocated prior to spinal anesthesia for cesarean delivery in preeclampsia and should be used with caution in women with multiple gestations.
Summary: Current evidence suggests that combining a prophylactic vasopressor regimen with HES preloading, HES coloading or crystalloid coloading is the best method of preventing maternal hypotension after the initiation of spinal anesthesia. Crystalloid preloading is clinically ineffective and thus should no longer be used.