Which vasopressor is preferred for a pregnant patient with hypotension during spinal or epidural anesthesia?

Which vasopressor is preferred for a pregnant patient with hypotension during spinal or epidural anesthesia?

• A. Epinephrine
• B. Norepinephrine
• C. Ephedrine
• D. Phenylephrine

Answer: (C)

The main idea here is to restore mom’s blood pressure in a way that also preserves or increases cardiac output so uteroplacental blood flow stays good. Ephedrine acts on both alpha and beta receptors, so it raises blood pressure (via some vasoconstriction) and, importantly, boosts heart rate and myocardial contractility (beta effects). That combination increases overall cardiac output, which helps maintain placental perfusion and fetal oxygen delivery during neuraxial anesthesia when venous pooling has reduced venous return. Pure vasopressors that mainly constrict blood vessels can raise pressure but may lower cardiac output and placental blood flow, which is less favorable for the fetus. Ephedrine historically offered advantages in this setting by supporting maternal perfusion and fetal status, making it the preferred choice in this scenario.

The main idea here is to restore mom’s blood pressure in a way that also preserves or increases cardiac output so uteroplacental blood flow stays good. Ephedrine acts on both alpha and beta receptors, so it raises blood pressure (via some vasoconstriction) and, importantly, boosts heart rate and myocardial contractility (beta effects). That combination increases overall cardiac output, which helps maintain placental perfusion and fetal oxygen delivery during neuraxial anesthesia when venous pooling has reduced venous return. Pure vasopressors that mainly constrict blood vessels can raise pressure but may lower cardiac output and placental blood flow, which is less favorable for the fetus. Ephedrine historically offered advantages in this setting by supporting maternal perfusion and fetal status, making it the preferred choice in this scenario.