Prophylactic Bolus Phenylephrine Versus Ephedrine and Neonatal First-Minute APGAR Scores in Elective Cesarean Delivery Under Spinal Anesthesia: A Double-Blind Randomized Controlled Trial

Abstract

Background. Hypotension after spinal anesthesia is common at cesarean delivery and can compromise maternal stability and uteroplacental perfusion. Phenylephrine and ephedrine are the main vasopressors, but infusions are often impractical without syringe pumps, so bolus regimens are needed.

Objective. To compare prophylactic bolus phenylephrine with ephedrine for maternal hemodynamic stability and the neonatal first-minute APGAR score.

Methods. In this prospective, double-blind, randomized trial in Malang, Indonesia, 42 ASA I–II parturients undergoing elective cesarean delivery under spinal anesthesia received phenylephrine 125 µg (Group P, n = 21) or ephedrine 10 mg (Group E, n = 21) intravenously immediately after the block. Blood pressure and heart rate were recorded for 18 minutes. The primary outcome was the first-minute APGAR score.

Results. Systolic pressure fell from baseline by 14.71 ± 10.42 mmHg (Group P) and 17.24 ± 11.81 mmHg (Group E) at 1 minute (p = 0.466) and by 4.33 ± 7.82 and 7.38 ± 8.42 mmHg at 18 minutes (p = 0.231); no time point differed significantly. First-minute APGAR scores were higher in Group P (7.62 ± 0.97 vs. 7.05 ± 0.74; t = 2.141, df = 40, p = 0.038; Cohen's d = 0.66), but fifth-minute scores were similar (9.81 ± 0.40 vs. 9.71 ± 0.46; p = 0.457).

Conclusion. Phenylephrine and ephedrine boluses gave similar maternal blood pressure, and phenylephrine was associated with a 0.57-point higher first-minute APGAR score within the normal range. Larger trials with cord blood gas analysis are needed before phenylephrine bolus is recommended as first-line.