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Obstetric spinal hypotension : preoperative risk factors and the development of a preliminary risk score – the PRAM score

SAMJ: South African Medical Journal, 2017-12, Vol.107 (12), p.1127-1131 [Peer Reviewed Journal]

COPYRIGHT 2017 Health & Medical Publishing Group ;COPYRIGHT 2017 Health & Medical Publishing Group ;This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. ;ISSN: 0256-9574 ;ISSN: 2078-5135 ;EISSN: 2078-5135 ;DOI: 10.7196/SAMJ.2017.v107i12.12390 ;PMID: 29262969

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  • Title:
    Obstetric spinal hypotension : preoperative risk factors and the development of a preliminary risk score – the PRAM score
  • Author: Cairns, C. ; Bishop, D.G. ; Rodseth, R.N. ; Grobbelaar, M.
  • Subjects: Diagnosis ; Evaluation ; Health Care Sciences & Services ; Health Policy & Services ; Health status indicators ; Hypotension ; Labor complications ; Labor, Complicated ; Medical Ethics ; Medicine, General & Internal ; Medicine, Legal ; Medicine, Research & Experimental
  • Is Part Of: SAMJ: South African Medical Journal, 2017-12, Vol.107 (12), p.1127-1131
  • Description: Background. Obstetric spinal hypotension is a common and important problem during caesarean delivery. Identifying patients at risk for hypotension may guide clinical decision-making and allow timeous referral. Objective. Using preoperative risk factors, to develop a simple scoring system to predict systolic hypotension. Methods. This prospective, single-centre, observational study of patients undergoing elective or urgent caesarean delivery assessed body mass index, baseline heart rate, baseline mean arterial pressure (MAP), maternal age, urgency of surgery (elective v. non-elective) and preoperative haemoglobin concentration as predictors of spinal hypotension (systolic blood pressure 90 bpm, age >25 years, MAP <90 mmHg – the PRAM score) for the prediction of systolic hypotension following obstetric spinal anaesthesia. Patients with three factors had a 53% chance of developing hypotension, compared with the overall incidence of 30%. The PRAM score showed good discrimination, with a c-statistic of 0.626 (95% CI 0.576 - 0.676) and good calibration. Conclusions. Preoperative heart rate, preoperative MAP and maternal age were predictive of hypotension in elective and emergency caesarean delivery. The PRAM score shows promise as a simple, practical means to identify these patients preoperatively, but requires prospective validation.
  • Publisher: South Africa: Health and Medical Publishing Group (HMPG)
  • Language: English;Portuguese
  • Identifier: ISSN: 0256-9574
    ISSN: 2078-5135
    EISSN: 2078-5135
    DOI: 10.7196/SAMJ.2017.v107i12.12390
    PMID: 29262969
  • Source: Open Access: African Journals Online
    SciELO
    Geneva Foundation Free Medical Journals at publisher websites
    Alma/SFX Local Collection
    DOAJ Directory of Open Access Journals
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