Maternal haemodynamics in pre‐eclampsia compared with normal pregnancy during caesarean delivery

• Published in: BJOG : an international journal of obstetrics and gynaecology 2006-06, Vol.113 (6), p.657-663
• Main Authors: Tihtonen, K, Kööbi, T, Yli‐Hankala, A, Huhtala, H, Uotila, J
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia; Anesthesia, Obstetrical; Anesthesia, Spinal; Biological and medical sciences; Blood Pressure - physiology; Caesarean delivery; Cardiography, Impedance; Cesarean Section; Delivery. Postpartum. Lactation; Diseases of mother, fetus and pregnancy; Female; Gynecology. Andrology. Obstetrics; haemodynamics; Heart Rate - physiology; Humans; Hypertension; Medical sciences; Obstetrics; Pre-Eclampsia - physiopathology; Pregnancy; Pregnancy. Fetus. Placenta; pre‐eclampsia; Prospective Studies; spinal anaesthesia; Stroke Volume - physiology; whole‐body impedance cardiography
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/j.1471-0528.2006.00931.x

Objective  To determine how pre‐eclampsia modifies maternal haemodynamics during caesarean delivery. Design  Prospective study. Setting  Tampere University Hospital, Finland. Population  Ten pre‐eclamptic parturients and ten healthy parturients with uncomplicated pregnancies scheduled for elective caesarean section under spinal anaesthesia. Methods  Haemodynamic parameters were assessed by whole‐body impedance cardiography noninvasively. Main outcome measures  Stroke index (SI), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI) and mean arterial pressure (MAP) were recorded before operation, continuously during caesarean section, during the period of dissipation of anaesthesia and on the second to fifth postpartum day. Results  Baseline haemodynamics in women with pre‐eclampsia differed significantly from healthy women in higher SVRI and MAP and lower SI and CI. In women with pre‐eclampsia, preload infusion increased both SI and HR, causing a significant rise in CI, while in healthy parturients, only HR rose. In both the groups, spinal blockade reduced SVRI but CI remained stable. At the moment of delivery, CI increased in both groups. In uncomplicated pregnancies, both SI and HR increased, but in women with pre‐eclampsia, SI was not altered and the rise in CI was due to an increase in HR only. After the reversal of anaesthesia, haemodynamics in the control group returned to baseline values, whereas in women with pre‐eclampsia, SI and CI fell to levels that were significantly lower than the levels observed before surgery. Conclusions  In women with pre‐eclampsia, inability to increase SI at the moment of delivery may suggest dysfunction of the left ventricle to adapt to volume load caused by delivery and prompts concern for the increased risk of pulmonary oedema.