Thoracic ultrasound evaluation and B-type natriuretic peptide value in elective cesarean section under spinal anesthesia

Abstract

Background: Pregnancy-induced changes in cardiovascular status make women more susceptible to pulmonary edema. During cesarean section, to counterbalance the effect of hypotension caused by spinal anesthesia, anesthesiologists must choose between two fundamental approaches to maintain the hemodynamic state-intravenous fluids or vasopressors-and this choice will depend upon their particular opinions and experience. We aim to assess for any correlations between thoracic ultrasound A-and B-line artifacts, brain natriuretic peptide (BNP) levels, and the amount of intraoperative fluids administered.Results: From December 2016 to August 2018, at the University-Hospital of Udine, we enrolled 80 consecutive pregnant women undergoing cesarean section. We observed a statistically significant difference in the volume of fluids administered in the first 24 h (p = 0.035) between the patients presenting B-lines in at least one basal area of their thoracic ultrasound and patients with no evident B-lines (AUC 66.4%; IC 0.49-0.83). Dividing the population on whether their BNP levels were higher or less than 20 pg/mL, no statistically significant difference was revealed with regard to fluids administered in the first 24 h (p = 0.537). Conclusions:Thoracic ultrasound is a non-invasive and easy-to-use tool for detecting fluid intolerance in pregnant women undergoing cesarean section. BNP levels were slow to rise following the cesarean section and did not show any clear correlation with fluid volumes administered.

Point-of-Care Lung Ultrasound Pattern in Healthy Parturients: Prevalence of Pulmonary Interstitial Syndrome Following Vaginal Delivery, Elective and Unplanned Intrapartum Cesarean Delivery

“…In our investigation, no woman undergoing VD or eCD had pulmonary interstitial syndrome detectable on LUS. This corresponds to recently published findings from a retrospective analysis in parturients undergoing elective CD, 20 that detected no pulmonary interstitial syndrome but had lung regions with a B-pattern in 12.5% of women. 20 The pathogenesis of B-lines on LUS includes a disbalance between alveolar air and EVLW, a change in lung porosity and increased parenchymal tissue ratio between collapsed and expanded alveoli.…”

“…This corresponds to recently published findings from a retrospective analysis in parturients undergoing elective CD, 20 that detected no pulmonary interstitial syndrome but had lung regions with a B-pattern in 12.5% of women. 20 The pathogenesis of B-lines on LUS includes a disbalance between alveolar air and EVLW, a change in lung porosity and increased parenchymal tissue ratio between collapsed and expanded alveoli. 23 We found a high number of focal areas with 3 or more B-lines on LUS (overall prevalence 20%–44%), occurring predominantly in lateral lung regions.…”

“…Limited data have been available on the prevalence of pulmonary interstitial syndrome in women undergoing a VD 19 or CD. 20 Findings from our study that followed international consensus recommendations on performing LUS 10 provide important prevalence data in the immediate postpartum setting. In our investigation, no woman undergoing VD or eCD had pulmonary interstitial syndrome detectable on LUS.…”

“…16,17 Compared to nonpregnant women, LUS patterns seem to be similar in healthy pregnant women at term. 18 However, data on the impact of labor and peripartum hemodynamic strain on LUS are limited, 19,20 and the incidence of subclinical pulmonary interstitial syndrome in peripartum women is unknown.…”

Continuous Maternal Hemodynamics Monitoring at Delivery Using a Novel, Noninvasive, Wireless, PPG-Based Sensor

“…Lung ultrasound can also serve as a helpful tool for detecting fluid intolerance. Although safe, these tools present logistical and cost issues and are operator dependent [16][17][18]. Over the recent years, technology has improved, allowing monitoring using whole-body bioimpedance and thoracic bioimpedance-based devices [19,20].…”