A 28-year-old woman at 36 weeks of gestation develops pre-eclampsia with severe features. She is scheduled for emergency caesarean section under spinal anaesthesia. Which fluid strategy is MOST appropriate to prevent spinal-induced hypotension in this patient?

• A Rapid preloading with 2 litres of crystalloid immediately before the block
• B Withholding IV fluids entirely to avoid pulmonary oedema
• C Administering 500 ml of colloid after the block only if hypotension occurs
• D Co-loading with a modest crystalloid bolus at the time of block placement, with vasopressor prophylaxis ✓

Explanation

Current evidence supports co-loading (giving fluid at the time of the block) combined with vasopressor prophylaxis (phenylephrine or ephedrine) for spinal anaesthesia in caesarean section. Preloading alone is ineffective because the fluid shifts rapidly. Aggressive preloading risks volume overload, especially in pre-eclamptic patients who are prone to pulmonary oedema. Withholding fluids entirely increases the risk of severe hypotension and fetal compromise.

Reference: Chestnut's Obstetric Anesthesia, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.