Transient fetal blood redistribution associated with maternal supine position

Silva, Karina P.; Hamamoto, Tatiana Emy Nishimoto Kawanami; Nomura, Roseli Mieko Yamamoto

doi:10.1515/jpm-2016-0288

Cited by 10 publications

(17 citation statements)

References 17 publications

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“…Our findings and those of others [ 20 , 63 ] suggest that some degree of cerebral redistribution occurs in the maternal supine sleep position. Furthermore, there is strong epidemiological evidence that the supine sleep position may be causative for some adverse outcomes, including stillbirth.…”

Section: Discussionsupporting

confidence: 85%

Sleep in the Supine Position During Pregnancy is Associated with Fetal Cerebral Redistribution

Robertson

Okano

Kumar

2020

JCM

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The supine sleep position in late pregnancy is a major risk factor for stillbirth, with a population attributable risk of 5.8% and one in four pregnant women reportedly sleeping in a supine position. Although the mechanisms linking the supine sleep position and late stillbirth remain unclear, there is evidence that it exacerbates pre-existing maternal sleep disordered breathing, which is another known risk factor for adverse perinatal outcomes. Given that maternal sleep position is a potentially modifiable risk factor, the aim of this study was to characterize and correlate uteroplacental and fetal hemodynamics, including cardiac function, in a cohort of women with apparently uncomplicated pregnancies with their nocturnal sleep position. This was a prospective observational cohort study at an Australian tertiary obstetric hospital. Women were asked to complete a series of questions related to their sleep position in late pregnancy after 35 weeks of completed gestation. They also underwent an ultrasound assessment where Doppler indices of various fetoplacental vessels and fetal cardiac function were measured. Regional cerebral perfusion was also assessed. Pregnancy outcome data was extracted from the electronic hospital database for analysis. A total of 274 women were included in the final analysis. Of these, 78.1% (214/274) reported no supine sleep, and 21.9% (60/274) reported going to sleep in a supine position. The middle cerebral artery, anterior cerebral artery, and vertebral artery pulsatility indices were all significantly lower in the supine sleep cohort, as was the cerebroplacental ratio. There were no significant differences in the mode or indication for delivery or in serious neonatal outcomes, including 5-min Apgar score < 7, acidosis, and neonatal intensive care unit admission between cohorts. Women in the supine cohort were more likely to have an infant with a BW > 90th centile (p = 0.04). This data demonstrates fetal brain sparing in association with the maternal supine sleep position in a low-risk population. This data contributes to the growing body of literature attempting to elucidate the etiological pathways responsible for the association of late stillbirth with the maternal supine sleep position.

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Section: Discussionsupporting

confidence: 85%

Sleep in the Supine Position During Pregnancy is Associated with Fetal Cerebral Redistribution

Robertson

Okano

Kumar

2020

JCM

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“…The different positions adopted by pregnant women may affect the maternal uteroplacental blood flow and interfere in fetal circulation 15 . As uterine blood flow may change in the maternal supine position, the exams in the present study were performed to avoid this aspect.…”

Section: Discussionmentioning

confidence: 99%

Effects of maternal anxiety on fetal and maternal circulation

Jorge

Nomura

2023

Rev. Assoc. Med. Bras.

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OBJECTIVE:The aim of this study was to evaluate the association between maternal anxiety in the third trimester and changes in fetal and maternal circulation assessed by Doppler velocimetry. METHODS: This is a prospective, cross-sectional study. The inclusion criteria were good health, a singleton pregnancy, maternal age between 18 and 40 years, and gestational age between 34 and 40 weeks. Doppler measurements included mean uterine artery pulsatility index, fetal middle cerebral artery pulsatility index, peak of systolic velocity, umbilical artery, and umbilical vein. The Beck Anxiety Inventory questionnaire, validated for the Brazilian population, with 21 self-reported items, was applied. RESULTS:The study included 34 pregnant women, and 6 (17.7%) presented a total Beck Anxiety Inventory score showing moderate or severe maternal anxiety. The mean maternal age was 28.1 years (SD 5.7 years); the mean gestational age at interview was 36.5 weeks (SD 1.8 weeks), and the mean Beck Anxiety Inventory total score was 12.3 (SD 9.8). The group with moderate or severe anxiety, compared to the group with minimal or mild anxiety, presented an association with lower maternal age (median 21.5 vs. 29.5 years, p=0.019), lower fetal umbilical vein blood flow (median 189.4 vs. 249.5 mL/min, p=0.047), and lower umbilical vein-corrected blood flow (median 68.5 vs. 84.9 mL/kg/min, p=0.038). CONCLUSION: Maternal anxiety may affect fetal circulation patterns in late pregnancy and is associated with reduced blood flow in the fetal umbilical vein. The underlying physiopathology needs further investigation.

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“…Still, they confirmed the protective activation of cerebral autoregulation and a temporary decrease in middle cerebral artery pulsatility index. 47 Cerebral vasodilation occurs as a response to hypoxaemia caused by placental insufficiency. However, whether the activation of the 'foetal brain sparing effect' is a good marker of positional adverse effects requires further investigations.…”

Section: Maternal Position and Foetal Compromisementioning

confidence: 99%

Supine hypotensive syndrome of pregnancy

Massoth

Chappell

Kranke

et al. 2021

European Journal of Anaesthesiology

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Since the first description of supine hypotensive syndrome in the 1950s, its potentially detrimental effects on otherwise healthy women during late pregnancy have become a persistent challenge in obstetric practice. Establishing a 158 left lateral tilt during labour and caesarean section is a fundamental principle of obstetric care, universally adopted and upheld by current guidelines and recommendations. Reassessment of the original landmark studies in the light of current physiological and anatomical knowledge questions adherence to this standard in clinical practice. The modern practice of providing vasopressor support during caesarean delivery under neuraxial anaesthesia appears to negate any potential negative effects of a maternal full supine position. Recent MRI studies provide evidence as to the cause of supine hypotension and the physiological effects of different maternal positions at term. This review highlights current data on the acute supine hypotensive syndrome in contrast to traditional knowledge and established practice.

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Transient fetal blood redistribution associated with maternal supine position

Cited by 10 publications

References 17 publications

Sleep in the Supine Position During Pregnancy is Associated with Fetal Cerebral Redistribution

Sleep in the Supine Position During Pregnancy is Associated with Fetal Cerebral Redistribution

Effects of maternal anxiety on fetal and maternal circulation

Supine hypotensive syndrome of pregnancy

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