Prospective observational study of serial cardiac output by transthoracic echocardiography in healthy pregnant women undergoing elective caesarean delivery

Dennis, A.T.; Arhanghelschi, I.; Simmons, S. W.; Royse, Colin

doi:10.1016/j.ijoa.2009.06.007

Cited by 20 publications

(13 citation statements)

References 45 publications

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“…This is consistent with the work of other groups [11, 12]. In addition, a small number of healthy pregnant women showed increases in MV E/septal e′ in the pathological range, indicating diastolic dysfunction, and pericardial effusions, consistent with findings in other studies [13, 14].…”

Section: Discussionsupporting

confidence: 92%

“…All analyses were performed by a biostatistician using STATA version 12 (Stata Software Inc., Chicago, IL, USA). The sample size was calculated using the mean and standard deviation of cardiac output as the primary outcome measurement in healthy pregnant women in a previous study [14]. Determining that a clinically relevant difference in cardiac output between healthy pregnant women and women with pre‐eclampsia was 750 ml.min −1 , a sample size of 40 women in each group was required for a power of 80% and a 5% type‐1 error.…”

Section: Methodsmentioning

confidence: 99%

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Haemodynamics in women with untreated pre‐eclampsia*

et al. 2012

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SummaryThis study aimed to compare the haemodynamics in healthy pregnant women with the haemodynamics in women with untreated pre-eclampsia, to determine the cardiovascular reason for hypertension in pre-eclampsia. 40 women with untreated pre-eclampsia, 40 matched healthy pregnant women and 20 non-pregnant women were studied using transthoracic echocardiography. Untreated pre-eclampsia demonstrated (mean (SD), healthy non-pregnant vs healthy pregnant vs untreated pre-eclampsia) increased cardiac output (3400 (752) vs 4109 (595) vs 4789 (1416) ml.min Pre-eclampsia is a significant multiple organ system disease of pregnancy [1]. Hypertension is the defining clinical feature [2][3][4], but the haemodynamic explanation for hypertension in pre-eclampsia is still controversial.Hypertension is determined by cardiac output and systemic vascular resistance. Although previous studies have examined aspects of the cardiovascular system in healthy pregnant women and in women with

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Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Haemodynamics in women with untreated pre‐eclampsia*

et al. 2012

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“…Using transthoracic echocardiography, the reference range for cardiac output in healthy term pregnant women is approximately 4.4–8 l.min −1 ; the peak value may be achieved at a range of different gestations from 28 to 38 weeks [45–48]. Researchers have also reported a reduction in both systolic and diastolic function near term [40, 49, 50], supporting the hypothesis that there is mild impairment of systolic and diastolic function [47–49]. In addition, healthy pregnancy is associated with a low colloid osmotic pressure to left ventricular end‐diastolic pressure gradient, thereby predisposing even healthy pregnant women to the risk of acute pulmonary oedema [51].…”

Section: Cardiac Function In Healthy Pregnancymentioning

confidence: 95%

Acute pulmonary oedema in pregnant women

Dennis

Solnordal²

2012

Anaesthesia

227

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SummaryAcute pulmonary oedema in pregnant women is an uncommon but life-threatening event. The aims of this review are to address why pulmonary oedema occurs in pregnant women and to discuss immediate management. We performed a systematic literature search of electronic databases including MEDLINE, EMBASE and the Cochrane Library, using the key words obstetrics, pregnancy, acute pulmonary oedema, pregnancy complications, maternal, cardiac function and haemodynamics. We present a simple clinical classification of acute pulmonary oedema in pregnancy into pulmonary oedema occurring in normotensive or hypotensive women (i.e. without hypertension), and acute pulmonary oedema occurring in hypertensive women, which allows focused management. Pre-eclampsia remains an important cause of hypertensive acute pulmonary oedema in pregnancy and preventive strategies include close clinical monitoring and restricted fluid administration. Immediate management of acute pulmonary oedema includes oxygenation, ventilation and circulation control with venodilators. Pregnancy-specific issues include consideration of the physiological changes of pregnancy, the risk of aspiration and difficult airway, reduced respiratory and metabolic reserve, avoidance of aortocaval compression and delivery of the fetus. Acute pulmonary oedema in pregnant women is a lifethreatening event. Despite improvements in the management of congestive heart failure in non-pregnant adults, it continues to cause significant morbidity and mortality in pregnancy. This is due to the superimposed issues of the physiological changes of pregnancy and the presence of the fetus, as well as the contributory effect of poorly understood pathophysiology of pregnancyrelated disease such as pre-eclampsia. The objective of this review is to present an overview of the physiology and pathophysiology underpinning acute pulmonary oedema in pregnancy and to consider the management issues specific to pregnancy, including risk reduction and preventative strategies. MethodsThe criteria for consideration of the literature that was reviewed included any systematic review, randomised controlled trial, observational study, case report or expert or consensus statement pertaining to pregnant women and their cardiovascular physiology, cardiovascular pathophysiology, acute pulmonary oedema, and management and interventions in pregnant women with acute pulmonary oedema. Electronic search strategies included searching the databases MEDLINE (until October 2011), EMBASE (until October 2011) and the Cochrane Library using the following key words: obstetrics; pregnancy; acute pulmonary oedema; pregnancy complications; maternal; cardiac function;

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“…The baseline cardiac output ranged from 4.4 to 9.4 L.min -1 , making it clear that a mean value for cardiac output is perhaps irrelevant in clinical setting. This widely variable cardiac output in healthy term pregnant women has been previously documented using both Doppler ultrasound and impedance technology 11,12 . A high resting heart rate at term was also seen.…”

Section: Discussionmentioning

confidence: 82%

Monitoramento não invasivo baseado na biorreatância revela instabilidade hemodinâmica significativa durante cesárea eletiva sob raquianestesia

Doherty

Ohashi

Downey

et al. 2011

Rev. Bras. Anestesiol.

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Background and objectives:Blood pressure monitoring offers a limited understanding of the hemodynamic consequences of spinal anesthesia for cesarean delivery. The purpose of this study was to assess, with the aid of a non-invasive cardiac output monitor based on bioreactance, the hemodynamic changes during elective cesarean delivery under spinal anesthesia in which intermittent boluses of phenylephrine were used to prevent and treat hypotension.

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Prospective observational study of serial cardiac output by transthoracic echocardiography in healthy pregnant women undergoing elective caesarean delivery

Cited by 20 publications

References 45 publications

Haemodynamics in women with untreated pre‐eclampsia*

Haemodynamics in women with untreated pre‐eclampsia*

Acute pulmonary oedema in pregnant women

Monitoramento não invasivo baseado na biorreatância revela instabilidade hemodinâmica significativa durante cesárea eletiva sob raquianestesia

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