Article

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: 1.99). 05/2005; 84(4):355-61. DOI: 10.1111/j.0001-6349.2005.00489.x
Source: PubMed

ABSTRACT 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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