Which vasopressor is preferred to maintain uteroplacental perfusion?

Which vasopressor is preferred to maintain uteroplacental perfusion?

• A. Phenylephrine to maintain uteroplacental perfusion
• B. Norepinephrine
• C. Epinephrine
• D. Dopamine

Answer: (A)

When uteroplacental perfusion is at risk, the goal is to raise maternal arterial pressure reliably without compromising placental blood flow. Phenylephrine is a pure alpha-1 agonist, so it quickly increases systemic vascular resistance and blood pressure. That rise in pressure improves the perfusion pressure across the placenta, helping maintain fetal oxygen delivery. It tends to preserve fetal acid–base status better than some other vasopressors and avoids the more pronounced fetal heart rate effects seen with alternatives. While other drugs can be used, phenylephrine is regarded as the first-line choice for maintaining uteroplacental perfusion after neuraxial anesthesia. Dopamine can cause more unpredictable effects and is less favorable in this setting, and norepinephrine or epinephrine have different profiles that are not as consistently preferred for this specific goal.

When uteroplacental perfusion is at risk, the goal is to raise maternal arterial pressure reliably without compromising placental blood flow. Phenylephrine is a pure alpha-1 agonist, so it quickly increases systemic vascular resistance and blood pressure. That rise in pressure improves the perfusion pressure across the placenta, helping maintain fetal oxygen delivery. It tends to preserve fetal acid–base status better than some other vasopressors and avoids the more pronounced fetal heart rate effects seen with alternatives. While other drugs can be used, phenylephrine is regarded as the first-line choice for maintaining uteroplacental perfusion after neuraxial anesthesia. Dopamine can cause more unpredictable effects and is less favorable in this setting, and norepinephrine or epinephrine have different profiles that are not as consistently preferred for this specific goal.