Cardiac hemodynamics before, during and after elective cesarean section under spinal anesthesia in low-risk women

Ram, Maya; Lavie, Anat; Lev, Shaul; Blecher, Yair; Amikam, Uri; Shulman, Yael; Avnon, Tomer; Weiner, Eran; Many, Ariel

doi:10.1038/jp.2017.53

Cited by 23 publications

(14 citation statements)

References 40 publications

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“…Contrary to past studies that showed an increase in CO after vaginal or cesarean delivery (most probably due to autotransfusion of uterine blood into the maternal systemic circulation and the administration of oxytocin), 7,27 removal of the fetus during elective cesarean sections in our study caused a marked decrease in CI, due to an increase in TPRI and a resultant decline in preload and SI.…”

Section: Discussioncontrasting

confidence: 99%

“…While this finding is refuted by previous study, 8 it is supported by a recent study in a similar population of parturients. 27 We hypothesize that the lack of decrease in TPRI after regional anesthesia may be attributed to the fact that the preoperative measurements were taken prior to entry into the operating room. At this point, the patient was at resting state, with a mean heart rate of 85.2 AE 13.9 bpm.…”

Section: Discussionmentioning

confidence: 99%

“…26 Recently, it has been used successfully in healthy patients with low-risk pregnancies undergoing elective cesarean sections, demonstrating feasibility of this technique. 27 It is relatively easy to use, and its wrist-to-wrist configuration is practical for the laboring woman, enabling continuous monitoring.…”

mentioning

confidence: 99%

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The Hemodynamics of Labor in Women Undergoing Vaginal and Cesarean Deliveries as Determined by Whole Body Bioimpedance

et al. 2017

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Hemodynamics of Labor in Women Undergoing Vaginal and Cesarean Deliveries as Determined by Whole Body Bioimpedance

et al. 2017

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“…This prospective longitudinal observational study was performed at a tertiary medical center. All the women were assessed for hemodynamic changes using the NICaS™ device while lying in the supine position with leftward tilt, as recently described by us [ 17 , 18 ], and at the following time points: 15–30 min before undergoing a CS (measurement #1), immediately after receiving spinal anesthesia (measurement #2), immediately after delivery of the newborn and the placenta (measurement #3), at the closure of abdominal fascia (measurement #4), within 24–36 h (measurement #5), and 48–72 h postpartum (measurement #6).…”

Section: Methodsmentioning

confidence: 99%

Maternal cardiovascular hemodynamics in normotensive versus preeclamptic pregnancies: a prospective longitudinal study using a noninvasive cardiac system (NICaS™)

Lavie

Ram

Lev

et al. 2018

BMC Pregnancy Childbirth

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BackgroundPreeclampsia is among the most common medical complications of pregnancy. The clinical utility of invasive hemodynamic monitoring in preeclampsia (e.g., Swan-Ganz catheter) is controversial. Thoracic impedance cardiography (TIC) and Doppler echocardiography are noninvasive techniques but they both have important limitations. NICaS™ (NI Medical, PetachTikva, Israel) is a noninvasive cardiac system for determining cardiac output (CO) that utilizes regional impedance cardiography (RIC) by noninvasively measuring the impedance signal in the periphery. It outperformed any other impedance cardiographic technology and was twice as accurate as TIC.MethodsWe used the NICaS™ system to compare the hemodynamic parameters of women with severe preeclampsia (PET group, n = 17) to a cohort of healthy normotensive pregnant women with a singleton pregnancy at term (control group, n = 62) (1/2015–6/2015). Heart rate (HR), stroke volume (SV), CO, total peripheral resistance (TPR) and mean arterial pressure (MAP) were measured 15–30 min before CS initiation, immediately after administering spinal anesthesia, immediately after delivery of the fetus and placenta, at the abdominal fascia closure and within 24–36 and 48–72 h postpartum.ResultsThe COs before and during the CS were significantly higher in the control group compared to the PET group (P < .05), but reached equivalent values within 24–36 h postpartum. CO peaked at delivery of the newborn and the placenta and started to decline afterwards in both groups. The MAP and TPR values were significantly higher in the PET group at all points of assessment except at 48–72 h postpartum when it was still significantly higher for MAP while the TPR only exhibited a higher trend but not statistically significant. The NICaS™ device noninvasively demonstrated low CO and high TPR profiles in the PET group compared to controls.ConclusionsThe immediate postpartum period is accompanied by the most dramatic hemodynamic changes and fluid shifts, during which the parturient should be closely monitored. The NICaS™ device may help the clinician to customize the most optimal management for individual parturients. Our findings require validation by further studies on larger samples.

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“…Several studies have been performed using invasive and non‐invasive devices during Cesarean section, but none has compared a non‐invasive device to the current clinical standard of monitoring maternal hemodynamic parameters during high‐risk Cesarean section. Furthermore, most published studies have relied on percentage error or difference to evaluate or compare monitors, even though such a comparison is inappropriate when a gold‐standard invasive monitoring method is lacking.…”

Section: Discussionmentioning

confidence: 99%

Cardiac output measurements during high‐risk Cesarean section using electrical bioreactance or arterial waveform analysis: assessment of agreement

Gutiérrez

Perry

Columb

et al. 2019

Ultrasound in Obstet & Gyne

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Objective Maternal hemodynamics change significantly during Cesarean section complicated by massive hemorrhage or severe hypertensive disease. Cardiac output (CO) monitoring aids early, goal-directed hemodynamic therapy. The aim of this study was to record hemodynamic changes observed during Cesarean section in pregnancies at high risk of hemodynamic instability, using invasive (LiDCOrapid™) and non-invasive (NICOM ® ) devices, and to assess agreement between the two devices in measuring CO.Methods Simultaneous intraoperative hemodynamic measurements were taken using the LiDCOrapid and NICOM devices, following standardized techniques, in women at high risk of hemodynamic instability undergoing Cesarean section. Agreement in CO measurements between the two devices was assessed using Bland-Altman plots and the agreement:tolerability index (ATI). Agreement analyses were performed for repeated measures in subjects, using centiles.Results From 10 women, 307 paired measurements were analyzed. Mean bias (defined as the mean difference in CO measurements between the LiDCOrapid and NICOM devices) was 3.05 (95% CI, 1.89 to 4.21) L/min. Limits of agreement ranged from −1.58 (95% CI, −4.47 to −0.14) to 7.68 (95% CI, 6.24 to 10.56) L/min. The resulting agreement interval was 9.26 L/min which returned an ATI of 2.3. Conclusions There are large mean differences between CO measurements obtained during Cesarean section usingCorrespondence to: the LiDCOrapid and NICOM hemodynamic monitors in pregnant women at high risk of hemodynamic instability, indicating that they should not be considered interchangeable clinically. There is an unacceptably low level of agreement (ATI > 2) in CO measurements between the devices, conferring a high risk of clinical misclassification during massive hemorrhage. Copyright

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Cardiac hemodynamics before, during and after elective cesarean section under spinal anesthesia in low-risk women

Cited by 23 publications

References 40 publications

The Hemodynamics of Labor in Women Undergoing Vaginal and Cesarean Deliveries as Determined by Whole Body Bioimpedance

The Hemodynamics of Labor in Women Undergoing Vaginal and Cesarean Deliveries as Determined by Whole Body Bioimpedance

Maternal cardiovascular hemodynamics in normotensive versus preeclamptic pregnancies: a prospective longitudinal study using a noninvasive cardiac system (NICaS™)

Cardiac output measurements during high‐risk Cesarean section using electrical bioreactance or arterial waveform analysis: assessment of agreement

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