Hemodynamic changes in women with symptoms of supine hypotensive syndrome

Humphries, Aimee; Mirjalili, S. Ali; Tarr, Gregory P.; Thompson, John M. D.; Stone, Peter

doi:10.1111/aogs.13789

Cited by 35 publications

(34 citation statements)

References 22 publications

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“…The Auckland Stillbirth Study (TASS) 2 was the first to show that women who reported going to sleep supine in the third trimester had a 2.5-fold increased risk of late stillbirth that was independent of other known major risk factors for stillbirth. This finding was biologically plausible and aligned with existing research on the effects of maternal supine position in the third trimester demonstrating vena-caval compression, [3][4][5] decreased maternal cardiac output, 4 6 increased maternal heart rate, 4 5 7 8 decreased uterine perfusion 8 9 Strengths and limitations of this study ► This is the first study to evaluate the success of a nationwide public health campaign on awareness and modification of late pregnancy going-to-sleep position. ► Responses were obtained from a New Zealand-wide convenience sample of pregnant women, with enrichment from socioeconomically disadvantaged communities that have an associated increased risk of stillbirth and health professionals who provide pregnancy care.…”

Section: Introductionsupporting

confidence: 79%

Modification of maternal late pregnancy sleep position: a survey evaluation of a New Zealand public health campaign

et al. 2021

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IntroductionA ‘Sleep-On-Side When Baby’s Inside’ public health campaign was initiated in New Zealand in 2018. This was in response to evidence that maternal supine going-to-sleep position was an independent risk factor for stillbirth from 28 weeks’ gestation. We evaluated the success of the campaign on awareness and modification of late pregnancy going-to-sleep position through nationwide surveys.Methods and analysisTwo web-based cross-sectional surveys were conducted over 12 weeks in 2019–2020 in a sample of (1) pregnant women ≥28 weeks, primary outcome of going-to-sleep position; and (2) health professionals providing pregnancy care, primary outcome of knowledge of going-to-sleep position and late stillbirth risk. Univariable logistic regression was performed to identify factors associated with supine going-to-sleep position.DiscussionThe survey of pregnant women comprised 1633 eligible participants. Going-to-sleep position last night was supine (30, 1.8%), non-supine (1597, 97.2%) and no recall (16, 1.0%). Supine position had decreased from 3.9% in our previous New Zealand-wide study (2012–2015). Most women (1412, 86.5%) had received sleep-on-side advice with no major resultant worry (1276, 90.4%). Two-thirds (918, 65.0%) had changed their going-to-sleep position based on advice, with most (611 of 918, 66.5%) reporting little difficulty. Supine position was associated with Māori (OR 5.05, 95% CI 2.10 to 12.1) and Asian-non-Indian (OR 4.20, 95% CI 1.27 to 13.90) ethnicity; single (OR 10.98, 95% CI 4.25 to 28.42) and cohabitating relationship status (OR 2.69, 95% CI 1.09 to 6.61); hospital-based maternity provider (OR 2.55, 95% CI 1.07 to 6.10); education overseas (OR 3.92, 95% CI 1.09 to 14.09) and primary-secondary level (OR 2.80, 95% CI 1.32 to 6.08); and not receiving sleep-on-side advice (OR 6.70, 95% CI 3.23 to 13.92). The majority of health professionals (709 eligible participants) reported awareness of supine going-to-sleep position and late stillbirth risk (543, 76.6%).ConclusionMost pregnant women had received and implemented sleep-on-side advice without major difficulty or concern. Some groups of women may need a tailored approach to acquisition of going-to-sleep position information.

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Section: Introductionsupporting

confidence: 79%

Modification of maternal late pregnancy sleep position: a survey evaluation of a New Zealand public health campaign

et al. 2021

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“…Moreover, in recent years, imaging examinations such as ultrasound and MRI have also been used to identify aortocaval compression by a gravid uterus. Humphries et al found that the IVC velocities at the level of origin and at the level of the renal veins was signi cantly reduced, while that of the azygos vein increased signi cantly on MRI [24,25]. This observation was made with the parturient in the supine position compared to the left lateral position in pregnancies between 34-38 weeks' gestation without anesthesia.…”

Section: Discussionmentioning

confidence: 97%

The transverse diameter of right common femoral vein by ultrasound in the supine position for predicting post-spinal hypotension during cesarean delivery.

Yao

Zhao

Zheng

et al. 2020

Preprint

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Background: Post-spinal anesthesia hypotension during cesarean delivery is caused by decreased systemic vascular resistance due to the blockage of autonomic nerves, which is further worsened by inferior vena cava (IVC) compression by the gravid uterus. The aim of this study was to assess whether peak velocity and diameter of IVC below the xiphoid or the right common femoral vein (RCFV) in the inguinal region, as measured on ultrasound, could reflect the degree of IVC compression and further identify parturients at risk of post-spinal hypotension.Methods: After 56 parturients underwent elective cesarean section with spinal anesthesia were included in this study, peak velocities and anteroposterior diameters of the IVC and peak velocities and transverse diameters of the RCFV were measured by ultrasound before anesthesia. The primary outcome was ultrasound measurements of IVC and RCFV, and their association with post-spinal hypotension during cesarean delivery. Hypotension was defined as having a drop of systolic arterial pressure >20% from the baseline. Multinomial logistic regression analysis was used to identify the association between the measurements of IVC, RCFV and post-spinal hypotension during cesarean delivery. Receiver operating characteristic curves were used to test the abilities of the identified parameters to predict post-spinal hypotension, and the areas under the curve and the optimum cut-off values for the predictive parameters were calculated.Results: Longer transverse diameter of the RCFV was associated with the occurrence of post-spinal hypotension (odds ratio = 2.022, 95% confidence interval [CI] 1.261–3.243). The area under the receiver operating characteristics curve for the prediction of post-spinal hypotension was 0.759 (0.628–0.890; P = 0.001). A transverse diameter of the RCFV >12.2 mm could predict post-spinal hypotension during cesarean delivery.Conclusions: We demonstrated a longer transverse diameter of RCFV was associated with hypotension and it could predict parturients at major risk of hypotension before anesthesia.Trial Registration: This study was registered at http://www.chictr.org.cn on 16, May, 2018. No. ChiCTR1800016163

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“…Moreover, in recent years, imaging examinations, such as ultrasound and MRI, have been used to identify aortocaval compression by a gravid uterus. Humphries et al found that the IVC velocities at the level of origin and at the level of the renal veins were significantly reduced, while that of the azygos vein increased significantly on MRI [24,25]. This observation was made with the parturient in the supine position, compared with those in the left lateral position, in pregnancies between 34 and 38 weeks of gestation without anesthesia.…”

Section: Discussionmentioning

confidence: 98%

The transverse diameter of right common femoral vein by ultrasound in the supine position for predicting post-spinal hypotension during cesarean delivery

et al. 2021

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Background Post-spinal anesthesia hypotension during cesarean delivery is caused by decreased systemic vascular resistance due to the blockage of the autonomic nerves, which is further worsened by inferior vena cava (IVC) compression by the gravid uterus. This study aimed to assess whether peak velocity and diameter of the IVC below the xiphoid or right common femoral vein (RCFV) in the inguinal region, as measured on ultrasound, could reflect the degree of IVC compression and further identify parturients at risk of post-spinal hypotension. Methods Fifty-six parturients who underwent elective cesarean section with spinal anesthesia were included in this study; peak velocities and anteroposterior diameters of the IVC and peak velocities and transverse diameters of the RCFV were measured using ultrasound before anesthesia. The primary outcome was the ultrasound measurements of IVC and RCFV acquired before spinal anesthesia and their association with post-spinal hypotension. Hypotension was defined as a drop in systolic arterial pressure by > 20% from the baseline. Multinomial logistic regression analysis was used to identify the association between the measurements of IVC, RCFV, and post-spinal hypotension during cesarean delivery. Receiver operating characteristic curves were used to test the abilities of the identified parameters to predict post-spinal hypotension; the areas under the curve and optimum cut-off values for the predictive parameters were calculated. Results A longer transverse diameter of the RCFV was associated with the occurrence of post-spinal hypotension (odds ratio = 2.022, 95% confidence interval [CI] 1.261–3.243). The area under the receiver operating characteristics curve for the prediction of post-spinal hypotension was 0.759 (95% CI 0.628–0.890, P = 0.001). A transverse diameter of > 12.2 mm of the RCFV could predict post-spinal hypotension during cesarean delivery. Conclusions A longer transverse diameter of RCFV was associated with hypotension and could predict parturients at a major risk of hypotension before anesthesia. Trial registration This study was registered at http://www.chictr.org.cn on 16, May, 2018. No. ChiCTR1800016163.

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Hemodynamic changes in women with symptoms of supine hypotensive syndrome

Cited by 35 publications

References 22 publications

Modification of maternal late pregnancy sleep position: a survey evaluation of a New Zealand public health campaign

Modification of maternal late pregnancy sleep position: a survey evaluation of a New Zealand public health campaign

The transverse diameter of right common femoral vein by ultrasound in the supine position for predicting post-spinal hypotension during cesarean delivery.

The transverse diameter of right common femoral vein by ultrasound in the supine position for predicting post-spinal hypotension during cesarean delivery

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