Maternal hemodynamics during cesarean delivery assessed by whole-body impedance cardiography

Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.
Acta Obstetricia Et Gynecologica Scandinavica (Impact Factor: 2.43). 05/2005; 84(4):355-61. DOI: 10.1111/j.0001-6349.2005.00489.x
Source: PubMed


This descriptive study was designed to evaluate maternal hemodynamics and cardiovascular responses to delivery during cesarean section (CS) under spinal anesthesia. We also assessed the feasibility of a noninvasive and continuous method of measuring cardiac output, namely whole-body impedance cardiography (ICG(WB)), during elective CS. Because of the techniques used in previous studies, only fractionated data on maternal hemodynamics during CS are available to date.
We studied 10 healthy women with normal pregnancies and two pregnant women with heart disease undergoing elective CS. Mean arterial pressure (MAP), heart rate (HR), stroke index (SI), cardiac index (CI) and systemic vascular resistance index (SVRI) were recorded continuously during CS, during the period of dissipation of anesthesia and on the second to fifth postpartum day. Analysis of variance for repeated measurements (anova) and the paired sample t-test were used in statistical analysis.
The hemodynamic parameters could be registered continuously during the whole procedure. At the point of delivery, a 47% increase in CI and a 39% decrease in SVRI were recorded, while MAP remained stable. These changes occurred within 2 min of delivery of the newborn and persisted on average for 10 min.
Sudden and significant hemodynamic changes take place at the moment of delivery. Intact physiological cardiovascular compensation mechanisms are needed to adapt to these challenges. Whole-body impedance cardiography may offer a useful noninvasive tool to monitor hemodynamics during cesarean section.

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    • "Normal vaginal delivery is associated with a 34% increase in cardiac output at full cervical dilation [4]. At the point of cesarean section delivery and in response to spinal anesthesia, a 47% increase in cardiac index and 39% decrease in SVR have been recorded [6] [8]. Following delivery, several factors lead to hemodynamic instability in the PH patients, including decreased preload from blood loss and anesthesia, increased preload from relief of caval obstruction, or additional blood return from the contracting uterus, abrupt increase of SVR and PVR to nonpregnancy state, and reduced ventricular contractility [2] [4] [9]. "
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    • "However, many clinicians are not aware of all the adverse effects of oxytocin. Even in a recently published clinical trial of hemodynamic changes during cesarean section, oxytocin-induced effects were not mentioned [2] [3]. The currently recommended dose of oxytocin is 5 U intravenously [5], which healthy pregnant women may tolerate well. "
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    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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