Öber Rüickenlagebeschwerden bei Graviden<sup>1</sup>

Ahltorp, Gideon

doi:10.3109/00016343509159870

Cited by 8 publications

(5 citation statements)

References 23 publications

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“…Our conclusion from this preliminary study was that the relaxed uterus more frequently causes compression of the maternal pelvic vessels during the upright position than has been reported from the recumbent position [1,17]. The venous return to the right ventricle becomes impeded, the stroke volume falls, and maternal heart rate in-creases in order to maintain cardiac output.…”

Section: Cardiovascular Changes During Maternal Upright Posturementioning

confidence: 59%

“…The upright position and its implication on pregnancy during the last trimester also has not been studied in detail [1,23,32]. In order to gather more knowledge about this topic, we investigated 15 healthy pregnant women during their last gestational trimester with a commercial lung function system (Ergostar, Co., Dr. Fenyves & Gut, Basel, 30).…”

Section: Pulmonary Changes In the Maternal Upright Posturementioning

confidence: 99%

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The implication of upright posture on pregnancy

Schneider

Deckardt²

1991

Jpme

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Pregnant women spend more than half of the day in an upright position. The physiological effects of this posture on the mother and the fetus are evaluated. Changes in vascular autoregulation and anatomy lead to maternal fainting in about 8% of women during early pregnancy. The immediate effects of such episodes on the fetus are unknown. There is a positive correlation of orthostatic dysregulations and abortions. In late pregnancy we found a significant increase in functional residual capacity in the upright posture. Minute volume and oxygen consumption were also significantly increase (p less than 0.001). Regarding the cardiovascular changes we detected a rhythmic change of the maternal heart rate with the change to upright position, which had not been published before. Change from the left lateral position to unsupported standing increased maternal heart rate by a mean of 27 beats per minute and a mean duration of 105 seconds in two thirds of the women. This was accompanied by a decreased cardiac output, systolic blood pressure and an increased oxygen consumption. The gravid uterus is responsible for these changes. During the upright position, the venous flow to the right ventricle is inhibited by the relaxed uterus. Contractions, leaning forward and the muscle pump improve the venous return. The phenomenon reached its maximum during the 38th week, where 71% of pregnant women displayed a cyclic change in heart rate. The fetal heart rate baseline is significantly increased in the upright position with a significantly reduced acceleration frequency (p less than 0.001). Combined with the data from epidemiologic studies, prolonged standing during late pregnancy may signal potential risks for the fetus such as low birth weight, prematurity and stillbirths because of an 'uterovascular syndrome'. Maternal standing possibly may be used as a physiological fetal stress test.

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Section: Cardiovascular Changes During Maternal Upright Posturementioning

confidence: 59%

Section: Pulmonary Changes In the Maternal Upright Posturementioning

confidence: 99%

The implication of upright posture on pregnancy

Schneider

Deckardt²

1991

Jpme

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“…44 He later found that 30% of 650 women avoided the supine position and 6% found it impossible due to severe symptoms. 45 Ahltorp suggested three possible causes, favouring the first: inferior vena cava occlusion, a utero-cardiac reflex or pathological elevation of the diaphragm. It was noted that both aorta and inferior vena cava could be compressed in the pathophysiology of this syndrome.…”

Section: Inferior Vena Cava Compression and Spinal Shockmentioning

confidence: 99%

“…The words used to describe the phenomenon reflected uncertainly of the aetiology. Ahltorp in 1932 referred to 'cardiac insufficiency in the dorsal position in pregnancy, 45 while other terms applied in the 1940-50 period included 'fainting in pregnancy' or 'a vaso-vagal fainting reaction'…”

Section: Inferior Vena Cava Compression and Spinal Shockmentioning

confidence: 99%

Regional anaesthesia for caesarean section in severe preeclampsia: spinal anaesthesia is the preferred choice

Sharwood-Smith¹,

Clark²,

Watson³

1999

International Journal of Obstetric Anesthesia

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Three clinical investigations together with a combined editorial and review of the cardiovascular physiology of spinal anaesthesia in normal and preeclamptic pregnancy form the basis of a thesis to be submitted for the degree of Doctor of Medicine at the University of St Andrews. First, the longstanding consensus that spinal anaesthesia could cause severe hypotension in severe preeclampsia was examined using three approaches. The doses of ephedrine required to maintain systolic blood pressure above predetermined limits were first compared in spinal versus epidural anaesthesia. The doses of ephedrine required were then similarly studied during spinal anaesthesia in preeclamptic versus normal control subjects. The principal outcome of these studies, that preeclamptic patients were resistant to hypotension after a spinal anaesthetic, was then further investigated by studying pulse transit time (PTT) changes in normal versus preeclamptic pregnancy. PTT was explored both as beat-to-beat monitor of cardiovascular function and also as an indicator of changes in arterial stiffness. The cardiovascular physiology of obstetric spinal anaesthesia was then reviewed in the light of the three clinical investigations, developments in reproductive vascular biology and the regulation of venous capacitance. It is argued that the theory of a role for vena caval compression as the single cause of spinal anaesthetic induced hypotension in obstetrics should be revised.

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“…In 1933 Ahltorp [1] published his clinical observation on the supine hypotensive shock syndrome in late pregnancy. His hypothesis that the venous return in the vena cava was impeded by the weight of the gravid uterus in the supine position and that the shocklike symptoms were induced by this was later confirmed by the angiographic studies performed by Kerr and Bieniarz [2,4] in the mid 1960s.…”

Section: Introductionmentioning

confidence: 99%

Premature Contractions: Are They Caused by Maternal Standing?

Schneider

Huch

1985

Acta genet. med. gemellol.: twin res.

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Abstract. In 33 out of 51 women studied in late gestation, the uterus was found to phasically compress the pelvic vessels and impede the venous blood flow during quiet standing. This caused a reduction of the cardiac stroke volume with resultant reduction of systemic blood pressure and a compensatory increased heart rate (range of increases 9-51 beats/ min). In all cases uterine contractions (mostly subclinical) coincided with the phase of circulatory readjustment. Apparently, the contracting uterus, by changing its position and/or shape, relieves the venous obstruction and prevents decompensation. In the women displaying the uterine compression syndrome (UCS), uterine activity was markedly increased in standing compared to the left recumbent position.It was also investigated whether the UCS appeared more often and earlier in gestation in women with twins. In all 9 women with twin pregnancies (mean gestational age 28 5/7 weeks) the UCS associated with uterine contractions was apparent in the standing posture. Although at present no definite conclusions can be reached on the effect on the cervix of these contractions, quiet standing especially in twin pregnancies seems to provoke an increased uterine activity and should therefore be avoided.

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Öber Rüickenlagebeschwerden bei Graviden¹

Cited by 8 publications

References 23 publications

The implication of upright posture on pregnancy

The implication of upright posture on pregnancy

Regional anaesthesia for caesarean section in severe preeclampsia: spinal anaesthesia is the preferred choice

Premature Contractions: Are They Caused by Maternal Standing?

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Öber Rüickenlagebeschwerden bei Graviden1

Cited by 8 publications

References 23 publications

The implication of upright posture on pregnancy

The implication of upright posture on pregnancy

Regional anaesthesia for caesarean section in severe preeclampsia: spinal anaesthesia is the preferred choice

Premature Contractions: Are They Caused by Maternal Standing?

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Öber Rüickenlagebeschwerden bei Graviden¹