Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Double Blind Randomized Controlled Trial of Phenylephrine for the Prevention of Spinal Induced Hypotension in Obese Parturients
Brief Summary: Previous research regarding the use of phenylephrine has excluded obese subjects (BMI \>35). This subgroup of patients represents a large portion of the obstetric patient population locally and nationally. It is unclear whether previous research should be extrapolated to the obese patient population. This study is being done to compare the incidence of hypotension, intraoperative nausea and vomiting, and neonatal acidosis between obese patients who receive a prophylactic phenylephrine infusion versus those who receive phenylephrine boluses for the treatment of established hypotension. This study will help us determine whether using a phenylephrine infusion or a phenylephrine bolus is the best way to prevent/treat spinal induced hypotension during cesarean deliveries in obese patients.


Options:
A: Inclusion Criteria:

* English speaking ASA I-II non-laboring women with single gestations ≥36 weeks
* Scheduled or unscheduled cesarean delivery under spinal anesthesia
* Height: 5 feet-5 feet 11 in.

Exclusion Criteria:

* Laboring women needing an emergency cesarean delivery

  * Subjects less than 18 years of age
  * Receipt of a drug with antiemetic properties in the 24 hours prior to cesarean section
  * Allergy to ondansetron, or metoclopramide
  * Severe hypertensive disease of pregnancy defined as systolic blood pressure (SBP)\>160mmHg, diastolic blood pressure (DBP)\>110mmHg requiring antihypertensive treatment or associated with significant proteinuria.
  * Severe Cardiac disease in pregnancy with marked functional limitations
  * Diabetes type I
  * Patients on Monoamine Oxidase Inhibitors or Tricyclic Antidepressants
  * Morbid obesity (body mass index (BMI)\>45)
  * Inclusion in another anesthetic study involving drug administration
B: Inclusion Criteria:

* Pregnant women in 28 weeks
* Women who will undergo repeated lower segment cesarean section

Exclusion Criteria:

* First cesarean section
* Placenta previa.
* Rupture uterus.
* Classical caesarean section.(upper segment cesarean section)
* Sever Preeclampsia.
* Chorioamnionitis.
* prolonged or obstructed labour.
* Fibroid.
* Polyhydramnios.
* Multiple pregnancy.
C: Inclusion Criteria:

* English speaking
* ASA Physical Status I-II
* Non-laboring women
* Single gestations ≥ 36 weeks
* Obese women (Body Mass Index 35 - 55 kg/m2)
* Non-emergent CD under spinal anesthesia

Exclusion Criteria:

* Height \< 5'0"
* Antiemetic drug use in the 24 hours prior to CD
* Allergy to phenylephrine, or any other standardized medication
* Hypertensive disease of pregnancy (i.e. mild \& severe preeclampsia)
* Chronic hypertension receiving antihypertensive treatment
* Severe Cardiac disease in pregnancy with marked functional limitations
* Patients on Monoamine Oxidase Inhibitors or Tricyclic Antidepressants
* Subject enrollment in another study involving a study medication within 30 days of CD
* Any other physical or psychiatric condition which may impair their ability to cooperate with study data collection
D: Inclusion Criteria:

* pregnant women
* 18 years of age or older
* presenting to MCV Hospital
* undergoing obstetrically indicated cesarean section
* english speaking

Exclusion Criteria:

* none

Answer: C