Colloid or crystalloid solution on maternal and neonatal hemodynamics for cesarean section: a meta-analysis of randomized controlled trials

Abstract

Aim: To compare the effect of colloid and crystalloid on maternal and neonatal hemodynamics in cesarean section.

Material and methods: We searched MEDLINE (PubMed, 1966-2011), EMBASE (1974-2011), http://www.clinicaltrials.gov, the Cochrane Controlled Clinical Trials Register Database, Biosis Preview, and the Chinese Biomedical Database (1980-2011). Randomized controlled trials involving healthy term patients undergoing scheduled cesarean delivery that compared the effect of colloid and crystalloid on hypotension, need for vasopressors, cardiac output, neonatal outcomes, and other adverse effects were analyzed.

Results: Ten trials of 853 patients were eligible for analysis. When colloid was used, significantly fewer hypotensive events occurred (odds ratio [OR] 3.21, 95% CI 2.15-4.53, number needed to treat = 4), less demand for vasopressors (standard mean difference [SMD] 0.77, 95% CI 0.34-1.21) and improved cardiac output (SMD -1.08, 95% CI -2.00 - -0.17). In subgroup analysis, the use of colloid reduced hypotensive events and adverse effects in Asian patients.

Conclusion: Colloid hydration should be considered first, especially in Asian patients, focusing on dosage and type of fluids. Preventive or therapeutic vasopressors may be required in a significant proportion of patients.