Normative postpartum intraabdominal pressure: Potential implications in the diagnosis of abdominal compartment syndrome

Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
American journal of obstetrics and gynecology (Impact Factor: 4.7). 08/2010; 203(2):149.e1-4. DOI: 10.1016/j.ajog.2010.02.055
Source: PubMed


We sought to establish normative values of intraabdominal pressure (IAP) in postpartum women with and without arterial hypertension.
Bladder pressure was measured via a Foley catheter 1 hour following completion of cesarean section in supine and semirecumbent positions in 21 patients.
Mean supine IAP (6.4 +/- 5.2 mm Hg) was significantly lower than semirecumbent IAP (11.6 +/- 7.2 mm Hg) (P < .05). Body mass index (BMI) was significantly correlated to IAP regardless of the gestational age (r(2) supine = 0.46, semirecumbent = 0.37; P = .004 for either). Increasing gravidity was associated with decreasing IAP. Patients with arterial hypertension had higher BMI, were delivered earlier, and had higher IAP than patients with normal arterial pressure, either in supine or semirecumbent position. However, these relationships were not significant when results were controlled for BMI.
Postcesarean section IAP is higher than in the general surgical population. Patients with hypertensive disorders have IAPs approaching to intraabdominal hypertension range.

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    • "Literature about postpartum IAP is scarce, as only three publications mention IAP measurements immediately after CS; Abdel-Razeq et al. and Fuchs et al. reported a IAP of 5.8 mmHg and around 11.1 mmHg, respectively [19], [20]. We observed a mean IAPMAL of 9.8±3.0 "
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    ABSTRACT: ObjectiveTo determine intra-abdominal pressure (IAP) and to evaluate the reproducibility of IAP-measurements using the Foley Manometer Low Volume (FMLV) in term uncomplicated pregnancies before and after caesarean section (CS), relative to two different reference points and to non-pregnant values.DesignObservational cohort study.SettingSecondary level referral center for feto-maternal medicine.PopulationTerm uncomplicated pregnant women as the case-group and non-pregnant patients undergoing a laparoscopic assisted vaginal hysterectomy (LAVH) as control group.MethodsIAP was measured in 23 term pregnant patients, before and after CS and in 27 women immediately after and 1 day after LAVH. The midaxillary line was used as zero-reference (IAPMAL) in all patients and in 13 CS and 13 LAVH patients, the symphysis pubis (IAPSP) was evaluated as additional zero-reference. Intraobserver correlation (ICC) was calculated for each zero-reference. Paired student's t-tests were performed to compare IAP values and Pearson's correlation was used to assess correlations between IAP and gestational variables.Main outcome measuresICC before and after surgery, IAP before and after CS, IAP after CS and LAVH.ResultsThe ICC for IAPMAL before CS was lower than after (0.71 versus 0.87). Both mean IAPMAL and IAPSP were significantly higher before CS than after: 14.0±2.6 mmHg versus 9.8±3.0 mmHg (p<0.0001) and 8.2±2.5 mmHg versus 3.5±1.9 mmHg (p = 0.010), respectively. After CS, IAP was not different from values measured in the LAVH-group.ConclusionIAP-measurements using FMLV is reproducible in pregnant women. Before CS, IAP is increased in the range of intra-abdominal hypertension for non-pregnant individuals. IAP significantly decreases to normal values after delivery.
    Full-text · Article · Aug 2014 · PLoS ONE
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    • "Given the evidence in the literature to date (Table 1), it is likely that term pregnancy is associated with elevated IAP to which the patient has adapted. It is also likely that the IAP is elevated in the immediate postpartum phase as well [32,50], similar to the postoperative surgical populations [51]. What remains to be seen is whether preeclamptic patients truly have IAH, at what pressure does this occur, and whether IAH has a significant role the in the progression of the development of severe preeclampsia or HELLP. "
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    ABSTRACT: The last several decades have seen many advances in the recognition and prevention of the abdominal compartment syndrome (ACS) and its precursor, intra-abdominal hypertension (IAH). There has also been a relative explosion of knowledge in the critical care, trauma, and surgical populations, and the inception of a society dedicated to its understanding, the World Society of the Abdominal Compartment Syndrome (WSACS). However, there has been almost no recognition or appreciation of the potential presence, influence, and management of intra-abdominal pressure (IAP), IAH, and ACS in pregnancy. This review highlights the importance and relevance of IAP in the critically ill parturient, the current lack of normative IAP values in pregnancy today, along with a review of the potential relationship between IAH and maternal diseases such as preeclampsia-eclampsia and its potential impact on fetal development. Finally, current IAP measurement guidelines are questioned, as they do not take into account the gravid uterus and its mechanical impact on intra-vesicular pressure.
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