Closed-loop vasopressor systems for hemodynamic stability during cesarean delivery and maternal and neonatal outcomes: a systematic review and meta-analysis
Authors' conclusion
Closed-loop vasopressor systems may improve systolic blood pressure fluctuations in cesarean deliveries with spinal anesthesia compared to manually adjusted vasopressor dosing
Study context
- Population
- Cesarean delivery under spinal anesthesia
- Participants
- 864 participants · 7 studies
- Comparison
- Closed-loop vasopressor systems vs manual vasopressor titration
- Outcome
- Closed-loop system performance (median performance error, median absolute performance error, wobble, divergence) and hemodynamic measures
Methodological detailsseparate meta-analyses for RCTs and observational studies, Cochrane risk of bias, Risk of bias low to moderate for all studies
- Separate meta-analyses for RCTs and observational studies
- Cochrane risk of bias
- Risk of bias low to moderate for all studies
Pooled result
As reported in the abstract
Primary outcomes, RCTs (3 RCTs, n = 654)
Closed-loop vs ManualMD, % (95 % CI)P value
Wobble
−0.66(−1.29 to −0.02)
P = 0.04Closed-loop vs ManualRelative risk (95 % CI)P value
Hypotension incidence
0.67(0.55–0.82)
P < 0.01Closed-loop vs ManualMD, mmHg (95 % CI)P value
Highest SBP
−4.05(−7.03 to −1.06)
P < 0.01Lowest SBP
5.39(2.17–8.60)
P < 0.01Further pooled results
| Outcome | RR (95 % CI) | P value | |
|---|---|---|---|
| Maternal nausea (RCTs)Moderate quality of evidence | 0.47 (0.26–0.85) | P = 0.01 | |
| 0.20.5125Relative risk (log scale) |
Pooled outcomes, observational studies (4 studies, n = 210)
- Median absolute performance error, wobble, divergence, hypotension incidence, highest and lowest SBP, highest and lowest heart rates, total fluids, total phenylephrine and ephedrine dosages statistically significant
Original publication
Closed-loop vasopressor systems for hemodynamic stability during cesarean delivery and maternal and neonatal outcomes: a systematic review and meta-analysis. Int J Obstet Anesth. Published 5 September 2025. doi:10.
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