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Sonnino C, Frassanito L, Piersanti A, Giuri PP, Zanfini BA, Catarci S, Draisci G. Impact of maternal lateral tilt on cardiac output during caesarean section under spinal anaesthesia: a prospective observational study. BMC Anesthesiol 2022; 22:103. [PMID: 35410115 PMCID: PMC8996426 DOI: 10.1186/s12871-022-01640-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left uterine displacement (LUD) has been questioned as an effective strategy to prevent aortocaval compression after spinal anesthesia (SA) for cesarean delivery (CD). We tested if LUD has a significant impact on cardiac output (CO) in patients undergoing CD under SA during continuous non-invasive hemodynamic monitoring with Clearsight. METHODS Forty-six patients were included in the final analysis. We considered 4 timepoints of 5 min each: T1 = baseline with LUD; T2 = baseline without LUD; T3 = after SA with LUD; T4 = after SA without LUD. LUD was then repositioned for CD. The primary outcome was to assess if CO decreased from T3 to T4 of at least 1.0 L/min. We also compared CO between T1 and T2 and other hemodynamic variables: mean, systolic and diastolic blood pressure (respectively MAP, SAP and DAP), heart rate (HR), stroke volume (SV), stroke volume variation (SVV), pulse pressure variation (PPV), contractility (dP/dt), dynamic arterial elastance (Eadyn) at the different timepoints. Data on fetal Apgar scores and umbilical arterial and venous pH were collected. RESULTS CO did not vary from T3 to T4 (CO mean difference -0.02 L/min [95% CI -0.88 to 0.82; P = 1). No significant variation was registered for any variable at any timepoint. CONCLUSIONS LUD did not show a significant impact on CO during continuous hemodynamic monitoring after SA for CD. TRIAL REGISTRATION (retrospectively registered on 03/12/2021) NCT05143684 .
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Affiliation(s)
- Chiara Sonnino
- Unit of Obstetric and Gynecologic Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.
| | - Luciano Frassanito
- Unit of Obstetric and Gynecologic Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Alessandra Piersanti
- Unit of Obstetric and Gynecologic Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Pietro Paolo Giuri
- Unit of Obstetric and Gynecologic Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Bruno Antonio Zanfini
- Unit of Obstetric and Gynecologic Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Stefano Catarci
- Unit of Obstetric and Gynecologic Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Gaetano Draisci
- Unit of Obstetric and Gynecologic Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
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Park YW, Lee IH. Effects of fetal position on maternal hemodynamics after spinal anesthesia for cesarean delivery. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.3.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Yeon Wook Park
- Department of Anesthesiology and Pain Medicine, Cheil General Hospital & Women’s Healthcare Center, Seoul, Korea
| | - In Ho Lee
- Department of Anesthesiology and Pain Medicine, Cheil General Hospital & Women’s Healthcare Center, Seoul, Korea
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Coleman J, Okere M, Seffah J, Kember A, O'Brien LM, Borazjani A, Butler M, Wells J, MacRitchie S, Isaac A, Chu K, Scott H. The Ghana PrenaBelt trial: a double-blind, sham-controlled, randomised clinical trial to evaluate the effect of maternal positional therapy during third-trimester sleep on birth weight. BMJ Open 2019; 9:e022981. [PMID: 31048420 PMCID: PMC6502032 DOI: 10.1136/bmjopen-2018-022981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the effect, on birth weight and birth weight centile, of use of the PrenaBelt, a maternal positional therapy device, during sleep in the home setting throughout the third trimester of pregnancy. DESIGN A double-blind, sham-controlled, randomised clinical trial. SETTING Conducted from September 2015 to May 2016, at a single, tertiary-level centre in Accra, Ghana. PARTICIPANTS Two-hundred participants entered the study. One-hundred-eighty-one participants completed the study. Participants were women, 18 to 35 years of age, with low-risk, singleton, pregnancies in their third-trimester, with body mass index <35 kg/m2 at the first antenatal appointment for the index pregnancy and without known foetal abnormalities, pregnancy complications or medical conditions complicating sleep. INTERVENTIONS Participants were randomised by computer-generated, one-to-one, simple randomisation to receive either the PrenaBelt or sham-PrenaBelt. Participants were instructed to wear their assigned device to sleep every night for the remainder of their pregnancy (approximately 12 weeks in total) and were provided a sleep diary to track their use. Allocation concealment was by unmarked, security-tinted, sealed envelopes. Participants and the outcomes assessor were blinded to allocation. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were birth weight and birth weight centile. Secondary outcomes included adherence to using the assigned device nightly, sleeping position, pregnancy outcomes and feedback from participants and maternity personnel. RESULTS One-hundred-sixty-seven participants were included in the primary analysis. The adherence to using the assigned device nightly was 56%. The mean ±SD birth weight in the PrenaBelt group (n=83) was 3191g±483 and in the sham-PrenaBelt group (n=84) was 3081g±484 (difference 110 g, 95% CI -38 to 258, p=0.14). The median (IQR) customised birth weight centile in the PrenaBelt group was 43% (18 to 67) and in the sham-PrenaBelt group was 31% (14 to 58) (difference 7%, 95% CI -2 to 17, p=0.11). CONCLUSIONS The PrenaBelt did not have a statistically significant effect on birth weight or birth weight centile in comparison to the sham-PrenaBelt. TRIAL REGISTRATION NUMBER NCT02379728.
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Affiliation(s)
- Jerry Coleman
- Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
- University of Ghana School of Medicine and Dentistry, Accra, Greater Accra, Ghana
| | - Maxfield Okere
- Biostatistics, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - Joseph Seffah
- Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
- University of Ghana School of Medicine and Dentistry, Accra, Greater Accra, Ghana
| | - Allan Kember
- Obstetrics & Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Louise M O'Brien
- University of Michigan Department of Obstetrics and Gynaecology, Ann Arbor, Michigan, USA
| | - Ali Borazjani
- Global Innovations for Reproductive Health & Life, Cleveland, Ohio, USA
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Michael Butler
- Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Jesse Wells
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Andre Isaac
- Innovative Canadians for Change, Edmonton, Alberta, Canada
| | - Kaishin Chu
- Method Squared Designhaus, Surrey, British Columbia, Canada
| | - Heather Scott
- Obstetrics & Gynaecology, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
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Kember AJ, Scott HM, O'Brien LM, Borazjani A, Butler MB, Wells JH, Isaac A, Chu K, Coleman J, Morrison DL. Modifying maternal sleep position in the third trimester of pregnancy with positional therapy: a randomised pilot trial. BMJ Open 2018; 8:e020256. [PMID: 30158217 PMCID: PMC6119420 DOI: 10.1136/bmjopen-2017-020256] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate whether the percentage of time spent supine during sleep in the third trimester of pregnancy could be reduced using a positional therapy device (PrenaBelt) compared with a sham device. DESIGN A double-blind, randomised, sham-controlled, cross-over pilot trial. SETTING Conducted between March 2016 and January 2017, at a single, tertiary-level centre in Canada. PARTICIPANTS 23 participants entered the study. 20 participants completed the study. Participants were low-risk, singleton, third-trimester pregnant women aged 18 years and older with body mass index <35 kg/m2 at the first antenatal appointment for the index pregnancy and without known fetal abnormalities, pregnancy complications or medical conditions complicating sleep. INTERVENTIONS A two-night, polysomnography study in a sleep laboratory. Participants were randomised by computer-generated, one-to-one, simple randomisation to receive either a PrenaBelt or a sham-PrenaBelt on the first night and were crossed over to the alternate device on the second night. Allocation concealment was by unmarked, security-tinted, sealed envelopes. Participants, the recruiter and personnel involved in setting up, conducting, scoring and interpreting the polysomnogram were blinded to allocation. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the percentage of time spent supine during sleep. Secondary outcomes included maternal sleep architecture, respiration, self-reported sleep position and feedback. RESULTS The median percentage of sleep time supine was reduced from 16.4% on the sham night to 3.5% on the PrenaBelt night (pseudomedian=5.8, p=0.03). We were unable to demonstrate differences in sleep architecture or respiration. Participants underestimated the time they spent sleeping supine by 7.0%, and six (30%) participants indicated they would make changes to the PrenaBelt. There were no harms in this study. CONCLUSIONS This study demonstrates that the percentage of sleep time supine during late pregnancy can be significantly reduced via positional therapy. TRIAL REGISTRATION NUMBER NCT02377817; Results.
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Affiliation(s)
- Allan J Kember
- Dalhousie Medical School, Halifax, Nova Scotia, Canada
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Global Innovations for Reproductive Health & Life, Cleveland, Ohio, USA
| | - Heather M Scott
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Louise M O'Brien
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ali Borazjani
- Global Innovations for Reproductive Health & Life, Cleveland, Ohio, USA
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | | | | | - Andre Isaac
- Innovative Canadians for Change, Edmonton, Alberta, Canada
| | - Kaishin Chu
- Method Squared Designhaus, Surrey, British Columbia, Canada
| | - Jerry Coleman
- Obstetrics and Gynaecology Department, Korle Bu Teaching Hospital, Accra, Ghana
- School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Debra L Morrison
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Warland J, Dorrian J, Kember AJ, Phillips C, Borazjani A, Morrison JL, O'Brien LM. Modifying Maternal Sleep Position in Late Pregnancy Through Positional Therapy: A Feasibility Study. J Clin Sleep Med 2018; 14:1387-1397. [PMID: 30092890 PMCID: PMC6086963 DOI: 10.5664/jcsm.7280] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 05/06/2018] [Accepted: 05/14/2018] [Indexed: 01/28/2023]
Abstract
STUDY OBJECTIVES To test whether a customized positional therapy device, PrenaBelt, would reduce time spent sleeping supine and evaluate any change in maternal or fetal parameters, in a group of healthy pregnant women in the third trimester of pregnancy. METHODS Participants underwent an in-home, overnight sleep study during late pregnancy (32-38 weeks). Participants were observed over 2 nights: 1 night when the PrenaBelt was not worn (nonintervention or control) and 1 night when it was (intervention). The intervention night was randomly allocated, and the study nights were consecutive. On the control night, participants were filmed using a night-capable (infrared) video camera, maternal sleep was measured by the Watch-PAT200, and the fetus was continuously monitored using the Monica AN24. On the intervention night, video, maternal, and fetal monitoring were repeated with the addition of the mother wearing the PrenaBelt. RESULTS A total of 25 healthy pregnant women were studied. Four had missing data for the Watch-PAT or Monica, and eight had missing or disrupted video data. Video-determined time in bed was not significantly different during intervention and control nights (P = .196, r = -.23). Median time spent supine during the intervention night was reduced from 48.3 minutes, to 28.5 minutes during the control night (P = .064, r = -.33). The difference in the proportion of time spent supine was significant (P = .039). There was no significant difference in objectively estimated sleep time (P = .651, r = -.07). Improvement was observed in both maternal and fetal parameters during the intervention night with an increase in median minimum maternal oxygen saturations (control = 91.6%, intervention = 92.4%, P = .006, r = -.42), fewer maternal oxygen desaturations (control = 7.1, intervention = 5.9, P = .095, r = -.26), and fewer fetal heart rate decelerations (control = 14.0, intervention = 10.4, P = .045, r = -.31) compared to the control night. CONCLUSIONS Results provide preliminary evidence that an intervention to reduce supine sleep in late pregnancy may provide maternal and fetal health benefits, with minimal effect on maternal perception of sleep quality and objectively estimated sleep time. Further research to explore relationships between objectively determined maternal sleep position, maternal respiratory indices, and fetal well-being is warranted.
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Affiliation(s)
- Jane Warland
- Mother's Babies and Families Research Group, School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Jillian Dorrian
- Behaviour-Brain-Body Research Centre, Sleep and Chronobiology Laboratory, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, South Australia, Australia
| | - Allan J. Kember
- Dalhousie Medical School, Dalhousie University, Halifax, Nova Scotia, Canada
- Global Innovations for Reproductive Health and Life (GIRHL) Cleveland, Ohio
| | - Craig Phillips
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia; Global Innovations for Reproductive Health and Life (GIRHL) Cleveland, Ohio
| | - Ali Borazjani
- Global Innovations for Reproductive Health and Life (GIRHL) Cleveland, Ohio
| | - Janna L. Morrison
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Louise M. O'Brien
- Sleep Disorders Center and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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Lemyze M, Guiot A, Mallat J, Thevenin D. The obesity supine death syndrome (OSDS). Obes Rev 2018; 19:550-556. [PMID: 29239066 DOI: 10.1111/obr.12655] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/01/2017] [Accepted: 11/03/2017] [Indexed: 11/29/2022]
Abstract
The obesity supine death syndrome refers to a catastrophic cascade of cardiorespiratory complications resulting from the supine positioning of a morbidly obese subject which can ultimately lead to death. It was first described in 1977 in two massively obese patients who were forced to lie down for medical procedures. But surprisingly, despite the current worldwide epidemic of obesity, very few cases have been reported yet. It can be assumed that the syndrome is poorly recognized in clinical practice and may participate in the high rate of unexplained death in morbidly obese patients. Based on the previously published cases and on those we met, this review aims at helping clinicians to early detect at-risk patients, to correctly diagnose this dramatic syndrome and to understand the underlying pathophysiology. More importantly, the main objective is to convince the attending clinicians that they have to do everything in their power to prevent obesity supine death syndrome occurrence by maintaining morbidly obese patients in the sitting or upright position whenever possible. When the syndrome unfortunately occurs, the best therapeutic approach is based on the immediate return to sitting position.
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Affiliation(s)
- M Lemyze
- Department of Respiratory and Critical Care Medicine, Schaffner Hospital, Lens, France
| | - A Guiot
- Department of Cardiology, Bois Bernard Hospital, Rouvroy, France
| | - J Mallat
- Intensive Care Unit, Arras Hospital, Arras, France
| | - D Thevenin
- Intensive Care Unit, Arras Hospital, Arras, France
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Left Lateral Table Tilt for Elective Cesarean Delivery under Spinal Anesthesia Has No Effect on Neonatal Acid–Base Status. Anesthesiology 2017; 127:241-249. [DOI: 10.1097/aln.0000000000001737] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Background
Current recommendations for women undergoing cesarean delivery include 15° left tilt for uterine displacement to prevent aortocaval compression, although this degree of tilt is practically never achieved. We hypothesized that under contemporary clinical practice, including a crystalloid coload and phenylephrine infusion targeted at maintaining baseline systolic blood pressure, there would be no effect of maternal position on neonatal acid base status in women undergoing elective cesarean delivery with spinal anesthesia.
Methods
Healthy women undergoing elective cesarean delivery were randomized (nonblinded) to supine horizontal (supine, n = 50) or 15° left tilt of the surgical table (tilt, n = 50) after spinal anesthesia (hyperbaric bupivacaine 12 mg, fentanyl 15 μg, preservative-free morphine 150 μg). Lactated Ringer’s 10 ml/kg and a phenylephrine infusion titrated to 100% baseline systolic blood pressure were initiated with intrathecal injection. The primary outcome was umbilical artery base excess.
Results
There were no differences in umbilical artery base excess or pH between groups. The mean umbilical artery base excess (± SD) was −0.5 mM (± 1.6) in the supine group (n = 50) versus −0.6 mM (± 1.5) in the tilt group (n = 47) (P = 0.64). During 15 min after spinal anesthesia, mean phenylephrine requirement was greater (P = 0.002), and mean cardiac output was lower (P = 0.014) in the supine group.
Conclusions
Maternal supine position during elective cesarean delivery with spinal anesthesia in healthy term women does not impair neonatal acid–base status compared to 15° left tilt, when maternal systolic blood pressure is maintained with a coload and phenylephrine infusion. These findings may not be generalized to emergency situations or nonreassuring fetal status.
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Fields JM, Catallo K, Au AK, Rotte M, Leventhal D, Weiner S, Ku BS. Resuscitation of the pregnant patient: What is the effect of patient positioning on inferior vena cava diameter? Resuscitation 2012. [PMID: 23178869 DOI: 10.1016/j.resuscitation.2012.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE Patients in the third trimester of pregnancy presenting to the emergency department (ED) with hypotension are routinely placed in the left lateral tilt (LLT) position to relieve inferior vena cava (IVC) compression from the gravid uterus thereby increasing venous return. However, the relationship between patient position and proximal intrahepatic IVC filling has never assessed directly. This study set out to determine the effect of LLT position on intrahepatic IVC diameter in third trimester patients under real-time visualization with ultrasound. METHODS This prospective observational study on the labor and delivery floor of a large urban academic teaching hospital enrolled patients between 30 and 42 weeks estimated gestational age from August 2011 to March 2012. Patients were placed in three different positions: supine, LLT, and right lateral tilt (RLT). After the patient was in each position for at least 3 min, IVC ultrasound using the intercostal window was performed by one of three study sonologists. Maternal and fetal hemodynamics were also monitored and recorded in each position. RESULTS A total of 26 patients were enrolled with one excluded from data analysis due to inability to obtain IVC measurements. The median IVC maximum diameter was 1.26 cm (95% confidence interval [CI] 1.13-1.55) in LLT compared to 1.13 cm (95% CI 0.89-1.41) in supine, p=0.01. When comparing each individual patient's LLT to supine measurement, LLT lead to an increase in maximum IVC diameter in 76% (19/25) of patients with the average LLT measurement 29% (95% confidence interval 10-48%) larger. Six patients had the largest maximum IVC measurement in the supine position. No patients experienced any hemodynamic instability or distress during the study. CONCLUSION IVC ultrasound is feasible in late pregnancy and demonstrates an increase in diameter with LLT positioning. However, a quarter of patients had a decrease in IVC diameter with tilting and, instead, had the largest IVC diameter in the supine position suggesting that uterine compression of the IVC may not occur universally. IVC assessment at the bedside may be a useful adjunct in determining optimal positioning for resuscitation of third trimester patients.
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Affiliation(s)
- J Matthew Fields
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States.
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Abstract
Cardiac disorders complicate less than 1% of all pregnancies. Physiologic changes in pregnancy may mimic heart disease. In order to differentiate these adaptations from pathologic conditions, an in-depth knowledge of cardiovascular physiology is mandatory. A comprehensive history, physical examination, electrocardiogram, chest radiograph, and echocardiogram are sufficient in most cases to confirm the diagnosis. Care of women with cardiac disease begins with preconception counseling. Severe lesions should be taken care of prior to contemplating pregnancy. Management principles for pregnant women are similar to those for the non-pregnant state. A team approach comprised of a maternal fetal medicine specialist, cardiologist, neonatologist, and anesthesiologist is essential to assure optimal outcome for both the mother and the fetus. Although fetal heart disease complicates only a small percentage of pregnancies, congenital heart disease causes more neonatal morbidity and mortality than any other congenital malformation. Unfortunately, screening approaches for fetal heart disease continue to miss a large percentage of cases. This weakness in fetal screening has important clinical implications, because the prenatal detection and diagnosis of congenital heart disease may improve the outcome for many of these fetal patients. In fact, simply the detection of major heart disease prenatally can improve neonatal outcome by avoiding discharge to home of neonates with ductal-dependent congenital heart disease. Fortunately, recent advances in screening techniques, an increased ability to change the prenatal natural history of many forms of fetal heart disease, and an increasing recognition of the importance of a multidisciplinary, team approach to the management of pregnancies complicated with fetal heart disease, together promise to improve the outcome of the fetus with congenital heart disease.
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Affiliation(s)
- Afshan B Hameed
- Maternal Fetal Medicine and Cardiology, University of California, Irvine, USA
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Macarthur A. Solving the problem of spinal-induced hypotension in obstetric anesthesia. Can J Anaesth 2002; 49:536-9. [PMID: 12067862 DOI: 10.1007/bf03017377] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Chen GY, Kuo CD, Yang MJ, Lo HM, Tsai YS. Comparison of supine and upright positions on autonomic nervous activity in late pregnancy: the role of aortocaval compression. Anaesthesia 1999; 54:215-9. [PMID: 10364855 DOI: 10.1046/j.1365-2044.1999.00648.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In order to understand the effect of aortocaval compression on autonomic nervous activity, we compared the effects of supine and upright postures on measures of heart rate variability in late pregnancy. Thirty-two women in late pregnancy and 23 nonpregnant age-matched women were studied. Both time and frequency domain heart rate variability measures were compared between the supine and upright positions, and between pregnant women and controls. The pregnant women had smaller mean RR interval, standard deviation of RR intervals and normalised high-frequency power, and a larger low- to high-frequency power ratio than nonpregnant women in the supine position. When the position was changed from upright to supine in nonpregnant women, the percentage change in the mean RR interval and normalised high-frequency power were increased, whereas the percentage change in the coefficient of variation of RR interval and low- to high-frequency power ratio were decreased. In contrast, the percentage change in normalised high-frequency power was decreased and the percentage change in low- to high-frequency power ratio was increased in pregnant women when the position was changed from upright to supine. These results indicate that the vagal enhancing effect seen in normal subjects when changing position from upright to supine was reversed in women in late pregnancy. Aortocaval compression in the supine position in pregnant women might be responsible for this reversal in the autonomic response to lying down.
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Affiliation(s)
- G Y Chen
- Department of Medicine, Provincial Tao-Yuan General Hospital, Tao-Yuan, Taiwan, ROC
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