Maternal hemodynamics in late gestation and immediate postpartum in singletons vs. twin pregnancies

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

doi:10.1007/s00404-017-4601-8

Cited by 11 publications

(7 citation statements)

References 35 publications

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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%

“…As previously described by our group [ 17 , 18 ], according to our institutional protocol every patient planned for elective CS is admitted to the hospital being “nothing per os” (NPO) from midnight prior to the CS. Two hours prior to surgery intravenous hydration is initiated with 1 l of Ringer’s lactate at a rate of 150 ml/hour, which is maintained until 1-h post- CS.…”

Section: Methodsmentioning

confidence: 99%

“…1 ). SV is calculated by measuring changes of electrical resistance as a result of volume changes of the arterial system {for detailed explanation of the formula please find [ 14 , 17 , 18 ]}.

Fig.…”

Section: Methodsmentioning

confidence: 99%

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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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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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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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“…Therefore, accurate measurement of cardiac output is important during pregnancy. The assessment of maternal hemodynamics may also be useful in the perioperative management of pregnancies that are at risk of volume overload and cardiac failure, such as women with twin pregnancies [12] and women with severe preeclampsia. [10].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, more emphasis has been put on the dynamic assessment of cardiovascular function (functional hemodynamics) rather than on the static measurements [ 12 – 17 ]. Passive leg raising (PLR), a maneuver that consists of passively lifting the lower limbs from the horizontal plane up to 45°, has been used as an endogenous fluid challenge test as it leads to a certain amount of blood volume being auto-transfused into the central circulation, which subsequently can be expected to increase the cardiac output by Frank–Starling mechanism [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Agreement between preload reserve measured by impedance cardiography and echocardiography during pregnancy

Liang

Vårtun

Acharya

2018

Arch Gynecol Obstet

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PurposeAccurate assessment of cardiac function is important during pregnancy. Echocardiography and impedance cardiography (ICG) are commonly used noninvasive methods to measure stroke volume (SV) and cardiac output (CO). The difference in stroke volume (ΔSV) or cardiac output (ΔCO) measured at baseline and after passive leg raising (PLR) is a measure of preload reserve that predicts volume responsiveness. However, the agreement between these two methods in measuring preload reserve during pregnancy is unclear. The aim of our study was to investigate the correlation and the agreement between Doppler echocardiography and ICG in assessing preload reserve in pregnant women.MethodsIn this prospective observational cross-sectional study, preload reserve was assessed by measuring the SV and CO during baseline and 90 s after PLR simultaneously by Doppler echocardiography and ICG in healthy pregnant women during the second and third trimesters. Bland–Altman analysis was used to determine the agreement between the two methods. Bias was calculated as the mean difference between two methods and precision as 1.96 SD of the difference.ResultsA total of 53 pregnant women were included. We found a statistically significant correlation between ΔSV (R = 0.56, p < 0.0001) and ΔCO (R = 0.39, p = 0.004) measured by ICG and Doppler echocardiography. The mean bias for ΔSV was 2.52 ml, with a precision of 18.19 ml. The mean bias for ΔCO was 0.21 l/min, with a precision of 1.51 l/min.ConclusionThere was a good agreement and a statistically significant correlation between ICG and Doppler echocardiography for measuring preload reserve.

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Comparing elective and emergency caesarean section by using bioimpedance method

Çavuş

Vahapoğlu

Türkmen

et al. 2023

Arch Gynecol Obstet

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Maternal hemodynamics in late gestation and immediate postpartum in singletons vs. twin pregnancies

Abstract: Hemodynamic parameters immediately before, during and shortly after CS in singleton and twin pregnancies are equivalent. Further evaluations of the value of NICaS™ in assessing cardiovascular-related pregnancy complications are warranted.

Cited by 11 publications

References 35 publications

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

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

Agreement between preload reserve measured by impedance cardiography and echocardiography during pregnancy

Comparing elective and emergency caesarean section by using bioimpedance method

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