Human Umbilical Artery Flow Velocity Waveforms Before and After Regional Anesthesia for Cesarean Section

Jc, Veille; Youngstrom, Paul C.; Kanaan, Camille; Wilson, Bayard

doi:10.1097/00006250-198812000-00016

Cited by 18 publications

(6 citation statements)

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“…Changes in umbilical artery Doppler velocity waveforms are thought to reflect changes in down- stream resistance in the fetal umbilical placental vascular bed. We found no change in the umbilical artery pulsatility index (PI) during extxadural anaesthesia, confirming previous findings [12,17]. However, PI increased after spinal injection of bupivacaine.…”

Section: Discussionsupporting

confidence: 91%

Maternal and Fetal Haemodynamic Effects of Spinal and Extradural Anaesthesia for Elective Caesarean Section

ROBSON¹

1992

British Journal of Anaesthesia

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Serial haemodynamic investigations were performed in 32 women who were allocated randomly to receive either spinal or extradural anaesthesia for elective Caesarean section. Cardiac output was measured by Doppler and cross-sectional echocardiography at the aortic valve. Doppler flow velocity waveforms were recorded also from the umbilical artery. Preloading with Ringer lactate solution 1 litre increased cardiac output in both groups. After injection of bupivacaine, cardiac output remained increased in the extradural group, but decreased in the spinal group. This was associated with an increase in umbilical artery pulsatility index in the spinal group. Umbilical artery pH was less in the spinal group (7.22 vs 7.27), although no neonate was depressed at birth. The maximum percentage change in cardiac output and umbilical artery pulsatility index correlated with umbilical artery pH (r = 0.54, r = 0.72, respectively). There was no significant correlation with change in arterial pressure.

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Section: Discussionsupporting

confidence: 91%

Maternal and Fetal Haemodynamic Effects of Spinal and Extradural Anaesthesia for Elective Caesarean Section

ROBSON¹

1992

British Journal of Anaesthesia

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“…Third, although the doses of adrenaline used by Skjoldebrand and colleagues were smaller (45-55 ug vs 90-100 ug) they administered the main dose of bupivacaine (15 or 19 ml) with adrenaline (37.5 or 47.5 ug) by rapid bolus injection, while we gave it in fractional amounts. Our results are consistent with some other previous reports, however, in that there were no changes in either uterine or umbilical artery blood flow waveforms after extradural lignocaine-adrenaline [11], the indices of umbilical artery waveforms remained unchanged when chloroprocaine was used with adrenaline [12] and an increase in blood flow in the fetal descending aorta was reported by Lindblad and colleagues after extradural bupivacaine containing adrenaline, but no change after etidocaine with adrenaline [13]. In all these cases the volume of crystalloid solution administered was at least 1500 ml.…”

Section: Table III Changes In Fetal Myocardial Contractility and In supporting

confidence: 93%

Effects of Extradural Bupivacaine With Adrenaline for Caesarean Section on Uteroplacental and Fetal Circulation

Alahuhta¹,

Räsänen

Jouppila³

et al. 1991

British Journal of Anaesthesia

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We have studied the effects of an extradural block using bupivacaine with adrenaline 90-100 micrograms on blood flow in the maternal uterine and placental arcuate arteries and the fetal umbilical, renal and middle cerebral arteries, using a colour Doppler technique in eight healthy parturients undergoing elective Caesarean section. Fetal myocardial function was investigated simultaneously by M-mode echocardiography. Maternal heart rate increased and diastolic arterial pressure decreased after extradural administration of bupivacaine with adrenaline. The latter effect was relieved by increasing the infusion rate in every case and none of the patients required vasopressors. There were no significant differences in maternal or fetal blood velocity waveforms, and no significant changes were found in any of the fetal myocardial measurements relative to control values. These observations suggest that extradural anaesthesia using bupivacaine with adrenaline does not have an adverse effect on vascular resistance in the uteroplacental or fetal circulations or on fetal myocardial function in normal pregnancy when bupivacaine-adrenaline is administered fractionally and maternal hypotension is prevented by rapid crystalloid volume loading.

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“…The blood flow in the umbilical artery did not change in our study. This finding is similar to that of Baumann et al (1990), Lindblad et al (1987) and Veille et al (1988), although Giles et al (1987) and Marx et al (1986) found a decrease in resistance in the umbilical artery.…”

Section: Discussionsupporting

confidence: 87%

“…Giles et al (1987) demonstrated a decrease in resistance in the fetal and uteroplacental circulations. These findings could not be confirmed for the uteroplacental circulation by Long et al (1988) or for the umbilical circulation by Veille et al (1988). However, Baumann et al (1990) showed an impairment in the uteroplacental circulation associated with a reduction in peripheral vascular resistance and an increase in leg blood flow after epidural anaesthesia for caesarean section.…”

mentioning

confidence: 77%

Epidural analgesia‐a cause of transient impairment of the utero‐placental circulation?

Olàh

Gee

1991

BJOG

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Human Umbilical Artery Flow Velocity Waveforms Before and After Regional Anesthesia for Cesarean Section

Cited by 18 publications

References 0 publications

Maternal and Fetal Haemodynamic Effects of Spinal and Extradural Anaesthesia for Elective Caesarean Section

Maternal and Fetal Haemodynamic Effects of Spinal and Extradural Anaesthesia for Elective Caesarean Section

Effects of Extradural Bupivacaine With Adrenaline for Caesarean Section on Uteroplacental and Fetal Circulation

Epidural analgesia‐a cause of transient impairment of the utero‐placental circulation?

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