Maternal collapse secondary to aortocaval compression

Murphy, C.; McCaul, Conán; Thornton, Patrick

doi:10.1016/j.ijoa.2015.05.007

Cited by 7 publications

(4 citation statements)

References 9 publications

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“…Also, our findings suggested that women with twin pregnancies may require a tilt angle of at least 45° to relieve the IVC compression to the same degree as women with singleton pregnancies. These findings partially address the conflict regarding whether lying on the left side at a tilt has maternal haemodynamic benefits and provide support for a case report indicating that a 30° tilt angle was ineffective for treating the hypotension observed when a woman with twins was positioned supine during caesarean delivery 18 . The reason for the different effects of the 30° and 45° tilt angles on IVC decompression between women with singleton and twin pregnancies is unclear.…”

Section: Discussionsupporting

confidence: 58%

“…Aortocaval compression in women with twin pregnancies has long been thought to be exaggerated because of the larger gravid uterus, and is considered a possible cause of more severe hypotension after spinal anaesthesia for caesarean section than is seen in women with a singleton pregnancy. 6,7,[16][17][18] This assumption, however, was never before confirmed or morphologically validated.…”

Section: Discussionmentioning

confidence: 99%

“…These findings partially address the conflict regarding whether lying on the left side at a tilt has maternal haemodynamic benefits and provide support for a case report indicating that a 308 tilt angle was ineffective for treating the hypotension observed when a woman with twins was positioned supine during caesarean delivery. 18 The reason for the different effects of the 308 and 458 tilt angles on IVC decompression between women with singleton and twin pregnancies is unclear. One possible explanation for this difference is uterine size.…”

Section: Discussionmentioning

confidence: 99%

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MRI of caval compression during left-lateral tilt in singleton and twin pregnancies

Fujita,

Higuchi,

Yonekura

2023

European Journal of Anaesthesiology

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BACKGROUND It is unclear how different degrees of left-lateral tilt affect the volumes of the abdominal aorta and inferior vena cava (IVC) in pregnancy. OBJECTIVE To use magnetic resonance images to assess the volumes of the abdominal aorta and IVC in women with twin or singleton pregnancies in different degrees of left-lateral tilt. DESIGN Prospective cohort study. SETTING A single-centre university hospital. PATIENTS Women with singleton pregnancies (13) and twin pregnancies (13) at 32 to 38 weeks’ gestation. MAIN OUTCOME MEASURES Comparison of abdominal aortic and IVC volumes measured by MRI in women with singleton and twin pregnancies while in the supine or left-lateral tilt position at 15°, 30° and 45°. RESULTS Supine, the mean aortic and IVC volumes were not significantly different between the women with singleton and twin pregnancies. In a left-lateral tilt position of 15o compared with supine, the mean IVC volume was not increased in either group (singletons: 6.3 ± 6.6 ml, 95% CI, −2.4 to 0.4; P = 0.174; twins: 3.9 ± 2.4 ml, 95% CI, −2.6 to 0.4; P = 0.138). At tilt angles of 30° or 45°, the mean IVC volume significantly increased (singletons 30°: 9.7 ± 5.8 ml, 95% CI, −6.1 to −2.7; P < .001; singleton 45°:13.8 ± 5.0 ml, 95% CI, −11.3 to −5.7; P < .001; twins 30°: 5.7 ± 2.1 ml, 95% CI, −4.0 to −1.4; P < .001; twins 45°: 12.8 ± 9.4 ml, 95% CI, −17.2 to −2.6; P = 0.003). Aortic volume was not significantly increased in either group at any of the examined tilt angles compared with the supine. CONCLUSION IVC volume is significantly increased by 30° and 45° left-lateral tilt positions compared with supine in women with singleton and twin pregnancies. TRIAL REGISTRATION This study was registered in the University Hospital Medical Information Network (UMIN) clinical trial registration (# UMIN000031273).

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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MRI of caval compression during left-lateral tilt in singleton and twin pregnancies

Fujita,

Higuchi,

Yonekura

2023

European Journal of Anaesthesiology

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“…However, it can cause bradycardia, especially when a bolus is given or an infusion is increased rapidly, and therefore ephedrine is recommended in the presence of hypotension with bradycardia [27]. Unrelieved inferior vena cava compression by the gravid uterus can reduce venous return and thus worsen hypotension and the predisposition to bradyarrhythmia [28][29][30]. Failure to adequately relieve vena cava compression has been highlighted as a contributory factor in maternal death cases [31].…”

Section: Discussionmentioning

confidence: 99%

Cardiac arrest in obstetric patients receiving anaesthetic care: results from the 7th National Audit Project of the Royal College of Anaesthetists

Lucas,

Kursumovic,

Cook

et al. 2024

Anaesthesia

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SummaryThe 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied peri‐operative cardiac arrest. Additional inclusion criteria for obstetric anaesthesia were: cardiac arrest associated with neuraxial block performed by an anaesthetist outside the operating theatre (labour epidural analgesia); and cardiac arrest associated with remifentanil patient‐controlled analgesia. There were 28 cases of cardiac arrest in obstetric patients, representing 3% of all cardiac arrests reported to NAP7, giving an incidence of 7.9 per 100,000 (95%CI 5.4–11.4 per 100,000). Obstetric patients were approximately four times less likely to have a cardiac arrest during anaesthesia care than patients having non‐obstetric surgery. The single leading cause of peri‐operative cardiac arrest in obstetric patients was haemorrhage, with underestimated severity and inadequate early resuscitation being contributory factors. When taken together, anaesthetic causes, high neuraxial block and bradyarrhythmia associated with spinal anaesthesia were the leading causes overall. Two patients had a cardiac arrest related to labour neuraxial analgesia. There were no cardiac arrests related to failed airway management or remifentanil patient‐controlled analgesia.

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Analgesia and Anaesthetic Considerations for Twins and Higher-Order Pregnancies

May

Lucas

2021

Twin and Higher-Order Pregnancies

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Maternal collapse secondary to aortocaval compression

Cited by 7 publications

References 9 publications

MRI of caval compression during left-lateral tilt in singleton and twin pregnancies

MRI of caval compression during left-lateral tilt in singleton and twin pregnancies

Cardiac arrest in obstetric patients receiving anaesthetic care: results from the 7th National Audit Project of the Royal College of Anaesthetists

Analgesia and Anaesthetic Considerations for Twins and Higher-Order Pregnancies

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