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

Abstract

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.

Comparison of hemodynamic change following spinal anesthesia in preeclamptic and non-preeclamptic parturients undergoing cesarean section at University of Gondar comprehensive specialized hospital, Northwest Ethiopia.

“…This result was in line with Nikooseresht M et al [10]. Similar to a study done by Lavie A et al [36], in our study, the total estimated blood loss was comparable between groups, and no blood products were required throughout the procedure.…”

“…Preeclampsia with severity feature/severe preeclampsia: Defined as a systolic arterial blood pressure of 160 mmHg or higher, or a diastolic blood pressure of 110 mmHg or higher, associated with proteinuria > 5 g in 24 hours [10,35]. Change in heart rate: When there was a 20% decrease or increase in heart rate from baseline [6,10,25,26,36]. The magnitude of hemodynamics change/severity of hypotension: The percentage falls of blood pressure (SBP, DBP, and MAP) between two measurements and it was calculated as:…”

Methods and considerations concerning cardiac output measurement in pregnant women: recommendations of the International Working Group on Maternal Hemodynamics

“…Multiple studies investigating CO during delivery using a modified pulse‐pressure method after arterial and central venous catheterization and continuous‐wave ultrasound have suggested that SV and CO increase during labor and immediately postpartum owing to pain, maternal bearing‐down efforts and the increase in venous return by autotransfusion from the contracted uterus and the sudden release of inferior vena cava obstruction. This has been accepted as common knowledge for several decades, but recent prospective studies using continuous measurements suggest a different perspective, with similar baseline hemodynamic parameters during the course of labor (stages 1 and 2 and postpartum) and substantial hemodynamic stress during contractions, without an increase in CO immediately postpartum.…”

Hemodynamic changes after spinal anesthesia in preeclamptic patients undergoing cesarean section at a tertiary referral center in Ethiopia: a prospective cohort study

“…However, spinal anesthesia-induced maternal hypotension is still the most frequent complication [16,17]. Anesthetists denied spinal anesthesia for preeclamptic parturients, due to the fear of profound hypotension and its management crisis (exaggerated response to vasopressor treatment and pulmonary edema following fluid challenges) [9,13,[18][19][20]. Furthermore, the incidence of spinal anesthesia-induced maternal hypotension showed inconsistency across different studies, which makes it almost difficult to set standard targets and develop a local management protocol [16,17,21].…”