Hypotension in Labour Ward
Hypotension may be defined as a drop of the systolic blood pressure below 100mmHg or a symptomatic drop in blood pressure. This definition isn't perfect but it works in practice.
Uterine blood flow is not autoregulated. The fetus relies on a good perfusion pressure and prolonged hypotension will cause fetal (and maternal) distress.
You may detect hypotension early with frequent blood pressure measurements or if you have overdone the bolus, the patient may complain of sudden nausea.
To treat it:
Put the patient in the left lateral position
Give 500-1000ml of saline IV
If required, give metaraminol 0.5mg IV or 6-12mg ephedrine IV
Continue frequent blood pressure measurements until the patient is stable
Call for help if you can't quickly stabilise the patient
Ephedrine 30mg IM can produce a more sustained effect