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Cardiac hemodynamics before, during and after elective cesarean section under spinal anesthesia in low-risk women

Journal of Perinatology volume 37, pages 793–799 (2017)Cite this article

Subjects

Abstract

Objective:

The aim of this study was to describe maternal central hemodynamic parameters before and during delivery as well at the early puerperium in healthy women undergoing elective cesarean section (CS) at term.

Study Design:

The noninvasive Cardiac System (NICaS, NI Medical, Petah-Tikva, Israel) is a regional impedance device that measures cardiac output (CO) and its derivatives with a good correlation with the gold standard Swan-Ganz catheter. We performed a prospective longitudinal study of healthy women with a singleton pregnancy at term. Maternal hemodynamic parameters were assessed by the NICaS at six time points: a few minutes before undergoing an elective CS, immediately after receiving spinal anesthesia, immediately after delivery of the fetus and placenta, after abdominal fascia closure, and within 24 to 36 and 48 to 72 h postpartum.

Result:

Sixty-one consenting women were recruited during the study period (January 2015 to June 2015). Baseline (pre-CS) mean arterial pressure (MAP) was 87.7±7.9 mm Hg, baseline CO was 7.5±1.7 l per min and baseline total peripheral resistance (TPR) was 994±301 dyne × s per cm5. After spinal anesthesia CO significantly increased by 13%, no significant changes were observed in MAP or TPR. Immediately after delivery, a nadir for all parameters was reached: MAP and TPR were significantly reduced by 8% and 26%, respectively (comparing to pre-CS), and CO further increased by 9% (24% comparing to pre-CS). After fascia closure, partial recoveries of all parameters were observed. Twenty-four to thirty-six hours postpartum MAP returned to pre-CS values, while CO and TPR reached −9% and +11% comparing to baseline, respectively. None of the parameters differed significantly between 24 to 36 and 48 to 72 h postpartum.

Conclusion:

Significant hemodynamic changes (reduction of TPR and increase of CO) take place at the time of delivery of fetus and placenta. Knowledge of normal hemodynamic values using a reliable noninvasive technique during various stages of pregnancy and the postpartum period is feasible, and might assist clinicians in assessing the level of patient deviation from expected cardiac performance, especially in high-risk women.

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Acknowledgements

This study was partially funded by a grant from NI Medical. SL has received consulting fees from NI Medical.

Author information

Author notes

  1. M Ram, A Lavie, S Lev, Y Blecher, U Amikam, Y Shulman, T Avnon, E Weiner and A Many: All affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

  2. M Ram and A Lavie: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    M Ram, A Lavie, Y Blecher, U Amikam, Y Shulman, T Avnon & A Many

  2. General ICU, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Israel

    S Lev

  3. Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel

    E Weiner

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  1. M Ram
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Corresponding author

Correspondence to M Ram.

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The authors declare no conflict of interest.

Additional information

This study was presented at the 36th pregnancy meeting of the Society for Maternal Fetal Medicine in Atlanta Georgia, US, 1 to 6 February 2016.

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Ram, M., Lavie, A., Lev, S. et al. Cardiac hemodynamics before, during and after elective cesarean section under spinal anesthesia in low-risk women. J Perinatol 37, 793–799 (2017). https://doi.org/10.1038/jp.2017.53

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