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Maternal haemodynamics in pre‐eclampsia compared with normal pregnancy during caesarean delivery
Author(s) -
Tihtonen K,
Kööbi T,
YliHankala A,
Huhtala H,
Uotila J
Publication year - 2006
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2006.00931.x
Subject(s) - medicine , eclampsia , impedance cardiography , preload , hemodynamics , anesthesia , vascular resistance , cardiac index , stroke volume , caesarean section , heart rate , cardiac output , blood pressure , pregnancy , obstetrics , genetics , biology
Objective To determine how pre‐eclampsia modifies maternal haemodynamics during caesarean delivery. Design Prospective study. Setting Tampere University Hospital, Finland. Population Ten pre‐eclamptic parturients and ten healthy parturients with uncomplicated pregnancies scheduled for elective caesarean section under spinal anaesthesia. Methods Haemodynamic parameters were assessed by whole‐body impedance cardiography noninvasively. Main outcome measures Stroke index (SI), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI) and mean arterial pressure (MAP) were recorded before operation, continuously during caesarean section, during the period of dissipation of anaesthesia and on the second to fifth postpartum day. Results Baseline haemodynamics in women with pre‐eclampsia differed significantly from healthy women in higher SVRI and MAP and lower SI and CI. In women with pre‐eclampsia, preload infusion increased both SI and HR, causing a significant rise in CI, while in healthy parturients, only HR rose. In both the groups, spinal blockade reduced SVRI but CI remained stable. At the moment of delivery, CI increased in both groups. In uncomplicated pregnancies, both SI and HR increased, but in women with pre‐eclampsia, SI was not altered and the rise in CI was due to an increase in HR only. After the reversal of anaesthesia, haemodynamics in the control group returned to baseline values, whereas in women with pre‐eclampsia, SI and CI fell to levels that were significantly lower than the levels observed before surgery. Conclusions In women with pre‐eclampsia, inability to increase SI at the moment of delivery may suggest dysfunction of the left ventricle to adapt to volume load caused by delivery and prompts concern for the increased risk of pulmonary oedema.