Maternal haemodynamics in pre-eclampsia compared with normal pregnancy during caesarean delivery

University of Tampere, Tammerfors, Pirkanmaa, Finland
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.45). 07/2006; 113(6):657-63. DOI: 10.1111/j.1471-0528.2006.00931.x
Source: PubMed

ABSTRACT To determine how pre-eclampsia modifies maternal haemodynamics during caesarean delivery.
Prospective study.
Tampere University Hospital, Finland.
Ten pre-eclamptic parturients and ten healthy parturients with uncomplicated pregnancies scheduled for elective caesarean section under spinal anaesthesia.
Haemodynamic parameters were assessed by whole-body impedance cardiography noninvasively.
Stroke index (SI), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI) and mean arterial pressure (MAP) were recorded before operation, continuously during caesarean section, during the period of dissipation of anaesthesia and on the second to fifth postpartum day.
Baseline haemodynamics in women with pre-eclampsia differed significantly from healthy women in higher SVRI and MAP and lower SI and CI. In women with pre-eclampsia, preload infusion increased both SI and HR, causing a significant rise in CI, while in healthy parturients, only HR rose. In both the groups, spinal blockade reduced SVRI but CI remained stable. At the moment of delivery, CI increased in both groups. In uncomplicated pregnancies, both SI and HR increased, but in women with pre-eclampsia, SI was not altered and the rise in CI was due to an increase in HR only. After the reversal of anaesthesia, haemodynamics in the control group returned to baseline values, whereas in women with pre-eclampsia, SI and CI fell to levels that were significantly lower than the levels observed before surgery.
In women with pre-eclampsia, inability to increase SI at the moment of delivery may suggest dysfunction of the left ventricle to adapt to volume load caused by delivery and prompts concern for the increased risk of pulmonary oedema.

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Available from: Tiit Kööbi, Sep 16, 2014
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    • "Women with pre-eclampsia have an increased rate of cesarean section consequent upon the high incidence of intrauterine growth restriction, fetal distress and prematurity.[2] Cesarean section on the other hand increases the risk of cardiopulmonary morbidity associated with pre-eclampsia.[3] This is due to the altered hemodynamics in women with pre-eclampsia.[4] This risk is present with both spinal and general anesthesia. "
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    ABSTRACT: To compare the outcome of subarachnoid block (spinal anesthesia) and general anesthesia in Cesarean delivery for women with severe pre-eclampsia. A retrospective study of women with severe pre-eclampsia requiring Cesarean section from January 2005 to June 2009 was carried out. Maternal age, parity, gestational age at delivery, booking status, Apgar scores, maternal and perinatal mortality of the sub-arachnoid block group were compared with those of general anesthesia group using χ(2), Student t-test and Fischer exact test. There were no significant difference between the two groups in overall maternal mortality (5.4% vs. 11.9%, P=0.5) and perinatal mortality (2.7% vs. 11.9%, P=0.15). The general anesthesia group had significantly more birth asphyxia than the spinal group (55.9% vs. 27.0%, P=0.0006). There was no significant difference in the maternal and perinatal mortality outcome of cesarean delivery between women with severe pre-eclampsia who had regional anesthesia and those that had general anesthesia. There was significantly higher proportion of birth asphyxia in babies of women who received general anesthesia.
    03/2011; 5(1):15-8. DOI:10.4103/1658-354X.76480
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    ABSTRACT: Recent literature on the anaesthetist's role in the management of the patient with severe pre-eclampsia is reviewed, with particular emphasis on the role of regional anaesthesia. Laboratory findings in pre-eclamptic women include increased levels of markers of oxidative stress and circulating tyrosine kinase 1, and inflammatory activation of leucocytes. Magnesium sulphate is the most effective agent for seizure prophylaxis. The optimal pharmacological agents for acute control of blood pressure remain controversial. The benefits of epidural analgesia in labour are well established. Single-shot spinal anaesthesia for caesarean section is safe in the absence of contraindications. Successful use of combined spinal-epidural anaesthesia has been described. Most studies on maternal haemodynamics have employed heart rate and blood pressure data as surrogate measures of cardiac output. Noninvasive cardiac output studies provide further insight into the haemodynamic response during neuraxial techniques for caesarean section. The value of regional anaesthesia cannot be over-emphasized. Recent research into spinal anaesthesia for caesarean section suggests a lower susceptibility to hypotension and probably less impairment of cardiac output than in healthy parturients. Noninvasive cardiac output measurement may also have advantages in critical care management.
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    ABSTRACT: Hemodynamic responses to spinal anesthesia (SA) for cesarean delivery in patients with severe preeclampsia are poorly understood. This study used a beat-by-beat monitor of cardiac output (CO) to characterize the response to SA. The hypothesis was that CO would decrease from baseline values by less than 20%. Fifteen patients with severe preeclampsia consented to an observational study. The monitor employed used pulse wave form analysis to estimate nominal stroke volume. Calibration was by lithium dilution. CO and systemic vascular resistance were derived from the measured stroke volume, heart rate, and mean arterial pressure. In addition, the hemodynamic effects of phenylephrine, the response to delivery and oxytocin, and hemodynamics during recovery from SA were recorded. Hemodynamic values were averaged for defined time intervals before, during, and after SA. Cardiac output remained stable from induction of SA until the time of request for analgesia. Mean arterial pressure and systemic vascular resistance decreased significantly from the time of adoption of the supine position until the end of surgery. After oxytocin administration, systemic vascular resistance decreased and heart rate and CO increased. Phenylephrine, 50 mug, increased mean arterial pressure to above target values and did not significantly change CO. At the time of recovery from SA, there were no clinically relevant changes from baseline hemodynamic values. Spinal anesthesia in severe preeclampsia was associated with clinically insignificant changes in CO. Phenylephrine restored mean arterial pressure but did not increase maternal CO. Oxytocin caused transient marked hypotension, tachycardia, and increases in CO.
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