Influence of reverse Trendelenburg position on aortocaval compression in obese pregnant women

Saravanakumar, Kandasamy; Hendrie, M.; Smith, F. W.; Danielian, Peter

doi:10.1016/j.ijoa.2015.09.007

Cited by 19 publications

(13 citation statements)

References 15 publications

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“…Many studies have demonstrated that velocities or diameters of the compressed IVC and AA could indicate the degree of aortocaval compression by the gravid uterus, and could change dramatically in the supine position during late pregnancy using magnetic resonance imaging (MRI). 10,11,12,13 Lee et al also demonstrated a dramatic change in cardiac output on suprasternal Doppler with patients in the supine position in late pregnancy. 14 However, none of these studies further clari ed the relationship between the degree of aortocaval compression and the incidence of hypotension after spinal anesthesia during cesarean delivery.…”

Section: Discussionmentioning

confidence: 93%

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 aortocaval compression by the gravid uterus. The aim of this study was to assess whether peak velocities and diameters of the abdominal aorta (AA) and inferior vena cava (IVC) below the xiphoid or the right common femoral artery (RCFA) and right common femoral vein (RCFV) in the inguinal region, as measured on ultrasound, could reflect the degree of aortocaval compression and further identify parturients at risk of post-spinal hypotension.Methods: After ultrasound measurement of peak velocities and anteroposterior diameters of the AA, and IVC and peak velocities and transverse diameters of the RCFA and RCFV before anesthesia, 56 parturients undergoing elective cesarean section with spinal anesthesia were enrolled in this study. Multinomial logistic regression analysis was used to identify the risk factors for 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: The transverse diameter of the RCFV was a risk factor for 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 longer than 12.2 mm could predict post-spinal hypotension during cesarean delivery. Conclusions: We demonstrated a higher transverse RCFV diameter was associated with hypotension and it could effectively predict parturients at 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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Section: Discussionmentioning

confidence: 93%

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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“…Despite the increasing use and perceived benefits of the ramped position for caesarean section, the literature regarding the benefit of a left lateral pelvic tilt in addition to this position is sparse, and left lateral displacement of the uterus is routinely used. A previous small observational study using magnetic resonance imaging in six patients found little evidence of improvements in aortocaval compression in a 15° head elevated position pelvic tilt position . However, there are no large studies looking at whether the addition of left lateral pelvic tilt to the head up position provides a haemodynamic benefit.…”

Section: Discussionmentioning

confidence: 96%

Echocardiographic determination of resting haemodynamics and optimal positioning in term pregnant women

et al. 2018

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Optimal positioning for anaesthesia in pregnant women involves balancing the need for ideal tracheal intubation conditions (achieved by the head elevated ramped position), with the prevention of reduced cardiac output from aortocaval compression (achieved by left lateral pelvic tilt). No studies have examined the effect on cardiac output of left lateral pelvic tilt in the ramped position. We studied non-labouring, non-anaesthetised healthy term pregnant women who underwent baseline (left lateral decubitus) cardiac assessment using transthoracic echocardiography. We then compared cardiac output, maternal physiological variables, fetal heart rate and comfort scores in three positions: left lateral decubitus; ramped position with wedge; and ramped position alone. Thirty women completed the study. Mean (SD) age, gestation and body mass index were 33.5 (3.93) years, 38.5 (0.94) weeks and 29.0 (4.0) kg.m , respectively. Mean ejection fraction, left ventricular internal diameter and mitral valve E/e' were 55.2 (6.8) %, 4.70 (0.43) cm and 7.50 (1.82), respectively. There were no differences in cardiac output between the positions (p = 0.503). There were no differences in systolic (p = 0.955) or diastolic (p = 0.987) blood pressure, maternal heart rate (p = 0.133), oxygen saturation, respiratory rate (p = 0.964) or fetal heart rate (p = 0.361) between ramped with wedge and ramped alone positions. Left lateral decubitus was most comfortable (p = 0.001), however, there were no differences in comfort levels between ramped with wedge and ramped alone positions. The ramped position without left lateral tilt is safe and acceptable in non-labouring, non-anaesthetised, healthy term pregnant women. Left lateral pelvic tilt may be unnecessary in the head elevated ramped position in term pregnant women.

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“…Many studies have demonstrated that the velocity or diameter of the compressed IVC could indicate the degree of aortocaval compression by the gravid uterus, and could change dramatically in the supine position during late pregnancy using magnetic resonance imaging (MRI) [12][13][14][15]. Lee et al also demonstrated a significant decrease in cardiac output on suprasternal Doppler, in late pregnancy, with parturients in the supine position, owing to IVC compression by the uterus [16].…”

Section: Discussionmentioning

confidence: 99%

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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Influence of reverse Trendelenburg position on aortocaval compression in obese pregnant women

Cited by 19 publications

References 15 publications

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

Echocardiographic determination of resting haemodynamics and optimal positioning in term pregnant women

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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