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Blood pressure and cardiac output during caesarean delivery under spinal anaesthesia: a prospective cohort study

OBJECTIVES: We have previously established a method to measure transfer of nutrients between mother, placenta and fetus in vivo. The method includes measurements of maternal and fetal blood flow by Doppler ultrasound prior to spinal anaesthesia. Spinal anaesthesia affects maternal blood pressure and...

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Autores principales: Michelsen, Trond Melbye, Tronstad, Christian, Rosseland, Leiv Arne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8204191/
https://www.ncbi.nlm.nih.gov/pubmed/34127491
http://dx.doi.org/10.1136/bmjopen-2020-046102
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author Michelsen, Trond Melbye
Tronstad, Christian
Rosseland, Leiv Arne
author_facet Michelsen, Trond Melbye
Tronstad, Christian
Rosseland, Leiv Arne
author_sort Michelsen, Trond Melbye
collection PubMed
description OBJECTIVES: We have previously established a method to measure transfer of nutrients between mother, placenta and fetus in vivo. The method includes measurements of maternal and fetal blood flow by Doppler ultrasound prior to spinal anaesthesia. Spinal anaesthesia affects maternal blood pressure and cardiac output. We aimed to determine the effect of spinal anaesthesia in mothers undergoing an elective caesarean section on blood pressure, heart rate and cardiac output, and whether cardiac output levels were comparable before induction of spinal anaesthesia and before delivery. DESIGN: Prospective cohort study. SETTING: Tertiary hospital in Norway. PARTICIPANTS: 76 healthy women with uneventful pregnancies undergoing an elective caesarean section. INTERVENTIONS: We induced spinal anaesthesia with a standard prevention of hypotension including intravenous fluid coloading and phenylephrine infusion. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measure was maternal cardiac output, and secondary outcome measures were invasive systolic blood pressure and heart rate. We measured heart rate and blood pressure by continuous invasive monitoring with a cannula in the radial artery. Cardiac output was estimated based on continuous arterial waveform. We compared maternal parameters 30 s before induction of spinal anaesthesia to 30 s before delivery. RESULTS: Median age at delivery was 34.5 (range 21–43) years and 17 of 76 women were nulliparous. The most prevalent indications were previous caesarean section and maternal request. Among 76 included women, 71 had sufficient data for analysis of endpoints. Median cardiac output was 6.51 (IQR (5.56–7.54) L/min before spinal anaesthesia and 6.40 (5.83–7.56) L/min before delivery (p=0.40)). Median invasive systolic blood pressure increased from 128.5 (120.1–142.7) mm Hg to 134.1 (124.0–146.6) mm Hg (p=0.014), and mean heart rate decreased from 86.0 (SD 13.9) to 75.2 (14.2) (p<0.001). CONCLUSIONS: Maternal cardiac output at the time of caesarean delivery is comparable to levels before induction of spinal anaesthesia. TRIAL REGISTRATION NUMBER: NCT00977769.
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spelling pubmed-82041912021-06-28 Blood pressure and cardiac output during caesarean delivery under spinal anaesthesia: a prospective cohort study Michelsen, Trond Melbye Tronstad, Christian Rosseland, Leiv Arne BMJ Open Obstetrics and Gynaecology OBJECTIVES: We have previously established a method to measure transfer of nutrients between mother, placenta and fetus in vivo. The method includes measurements of maternal and fetal blood flow by Doppler ultrasound prior to spinal anaesthesia. Spinal anaesthesia affects maternal blood pressure and cardiac output. We aimed to determine the effect of spinal anaesthesia in mothers undergoing an elective caesarean section on blood pressure, heart rate and cardiac output, and whether cardiac output levels were comparable before induction of spinal anaesthesia and before delivery. DESIGN: Prospective cohort study. SETTING: Tertiary hospital in Norway. PARTICIPANTS: 76 healthy women with uneventful pregnancies undergoing an elective caesarean section. INTERVENTIONS: We induced spinal anaesthesia with a standard prevention of hypotension including intravenous fluid coloading and phenylephrine infusion. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measure was maternal cardiac output, and secondary outcome measures were invasive systolic blood pressure and heart rate. We measured heart rate and blood pressure by continuous invasive monitoring with a cannula in the radial artery. Cardiac output was estimated based on continuous arterial waveform. We compared maternal parameters 30 s before induction of spinal anaesthesia to 30 s before delivery. RESULTS: Median age at delivery was 34.5 (range 21–43) years and 17 of 76 women were nulliparous. The most prevalent indications were previous caesarean section and maternal request. Among 76 included women, 71 had sufficient data for analysis of endpoints. Median cardiac output was 6.51 (IQR (5.56–7.54) L/min before spinal anaesthesia and 6.40 (5.83–7.56) L/min before delivery (p=0.40)). Median invasive systolic blood pressure increased from 128.5 (120.1–142.7) mm Hg to 134.1 (124.0–146.6) mm Hg (p=0.014), and mean heart rate decreased from 86.0 (SD 13.9) to 75.2 (14.2) (p<0.001). CONCLUSIONS: Maternal cardiac output at the time of caesarean delivery is comparable to levels before induction of spinal anaesthesia. TRIAL REGISTRATION NUMBER: NCT00977769. BMJ Publishing Group 2021-06-14 /pmc/articles/PMC8204191/ /pubmed/34127491 http://dx.doi.org/10.1136/bmjopen-2020-046102 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Obstetrics and Gynaecology
Michelsen, Trond Melbye
Tronstad, Christian
Rosseland, Leiv Arne
Blood pressure and cardiac output during caesarean delivery under spinal anaesthesia: a prospective cohort study
title Blood pressure and cardiac output during caesarean delivery under spinal anaesthesia: a prospective cohort study
title_full Blood pressure and cardiac output during caesarean delivery under spinal anaesthesia: a prospective cohort study
title_fullStr Blood pressure and cardiac output during caesarean delivery under spinal anaesthesia: a prospective cohort study
title_full_unstemmed Blood pressure and cardiac output during caesarean delivery under spinal anaesthesia: a prospective cohort study
title_short Blood pressure and cardiac output during caesarean delivery under spinal anaesthesia: a prospective cohort study
title_sort blood pressure and cardiac output during caesarean delivery under spinal anaesthesia: a prospective cohort study
topic Obstetrics and Gynaecology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8204191/
https://www.ncbi.nlm.nih.gov/pubmed/34127491
http://dx.doi.org/10.1136/bmjopen-2020-046102
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