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Cesarean; cardiac output

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https://www.readbyqxmd.com/read/27720613/an-open-label-randomized-controlled-clinical-trial-for-comparison-of-continuous-phenylephrine-versus-norepinephrine-infusion-in-prevention-of-spinal-hypotension-during-cesarean-delivery
#1
M C Vallejo, A F Attaallah, O M Elzamzamy, D T Cifarelli, A L Phelps, G R Hobbs, R E Shapiro, P Ranganathan
BACKGROUND: During spinal anesthesia for cesarean delivery phenylephrine is the vasopressor of choice but can cause bradycardia. Norepinephrine has both β- and α-adrenergic activity suitable for maintaining blood pressure with less bradycardia. We hypothesized that norepinephrine would be superior to phenylephrine, requiring fewer rescue bolus interventions to maintain blood pressure. METHODS: Eighty-five parturients having spinal anesthesia for elective cesarean delivery were randomized to Group P (phenylephrine 0...
August 28, 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/27662063/delayed-neuraxial-hematoma-in-parturient-with-fontan-circulation-following-neuraxial-anesthesia-for-cesarean-section
#2
Chukwudi O Chiaghana, Justin M Bremer, Joshua W Sappenfield, Adam L Wendling
OBJECTIVE: Neuraxial hematoma is a rare complication of spinal or epidural anesthesia. However, variable coagulation factor defects are relatively common in patients with Fontan circulation, and may predispose such patients to either increased risk of thrombosis or coagulopathy. These defects may indirectly increase their risk of neuraxial hematoma. CASE REPORT: We report a case of delayed neuraxial hematoma after the start of full-dose anticoagulation for pulmonary embolus on a postpartum patient with Fontan physiology who had continuous spinal anesthesia for cesarean delivery 4 days earlier...
September 22, 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27580274/management-strategy-of-umbilical-artery-aneurysm-complicated-by-cardiac-anomaly-case-study-and-literature-review
#3
Rikako Matsuki, Satoshi Nakago, Hiroki Kato, Takashi Shibata, Tomoki Kotera, Fumikazu Kotsuji
OBJECTIVE: Key considerations for managing an umbilical artery aneurysm (UAA) are a timely termination and the prevention of rupture of the UAA during delivery. Herein, we propose a treatment strategy based on our experience of UAA complicated by a fetal cardiac anomaly. CASE: A case of UAA was referred to our hospital at 23 weeks of gestation. The UAA increased its size to 6 cm. The blood reservoir within the UAA was presumed to be equivalent to the circulating blood volume of the fetus...
August 31, 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27491768/echocardiography-in-pregnancy-part-1
#4
REVIEW
Shuang Liu, Uri Elkayam, Tasneem Z Naqvi
Cardiovascular disease (CVD) remains the leading cause of maternal mortality, and clinical diagnosis of CVD in women during pregnancy is challenging. Pregnant women with known heart disease require careful multidisciplinary management by obstetric and medical teams to assess for maternal and fetal risk. Echocardiography is a safe and effective diagnostic tool indicated in pregnant women with cardiac symptoms or women with known cardiac disease for appropriate selection of women who require close monitoring of cardiac condition and valvular function...
September 2016: Current Cardiology Reports
https://www.readbyqxmd.com/read/27433072/epidural-anesthesia-a-safe-option-for-cesarean-section-in-parturient-with-severe-pulmonary-hypertension
#5
Sreyashi Sen, Sourav Chatterjee, Pinaki Mazumder, Sudakshina Mukherji
Rheumatic heart disease is the most common cardiac disease complicating pregnancy in developing countries. Heart disease accounts for 15% pregnancy-related mortality. In the presence of maternal heart disease, the circulatory changes of pregnancy may result in exacerbation of the hemodynamic perturbations due to complex cardiac valvular lesions leading to decompensation or death of mother or fetus. Determining the ideal anesthetic technique for cesarean section in the presence of complex cardiac conditions remains a much debated topic...
July 2016: Journal of Natural Science, Biology, and Medicine
https://www.readbyqxmd.com/read/27082710/placental-and-fetal-hemodynamics-in-prolonged-pregnancies
#6
Tuomas Kauppinen, Tiina Kantomaa, Aydin Tekay, Kaarin Mäkikallio
OBJECTIVE: We hypothesized that Doppler measurements of the placental and fetal central and peripheral hemodynamics would predict adverse outcomes in prolonged uncomplicated singleton pregnancies. METHOD: A total of 160 participants were recruited to this study. Doppler measurements of placental and fetal hemodynamics as well as cardiotocography (CTG) were assessed prior to induction of labor at >41+ weeks. CTG during delivery, umbilical artery (UA) pH and base excess at birth and neonatal data were evaluated...
July 2016: Prenatal Diagnosis
https://www.readbyqxmd.com/read/26991619/hemodynamics-of-phenylephrine-infusion-versus-lower-extremity-compression-during-spinal-anesthesia-for-cesarean-delivery-a-randomized-double-blind-placebo-controlled-study
#7
RANDOMIZED CONTROLLED TRIAL
Jana Christine Kuhn, Tor Hugo Hauge, Leiv Arne Rosseland, Vegard Dahl, Eldrid Langesæter
BACKGROUND: Phenylephrine infusion is the current first-line choice for prevention of spinal hypotension during cesarean delivery. The optimal dosage regimen is still undetermined. A mechanical alternative, lower limb wrapping, has been examined in a few small studies showing moderate success. In this trial, we compared the effect of leg wrapping with low-dose phenylephrine infusion and with placebo treatment on systolic arterial blood pressure during spinal anesthesia for cesarean delivery...
April 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/26939491/-supraventricular-tachycardia-during-pregnancy
#8
Lara Lehtoranta, Maija Valta, Riku Aantaa, Antti Perheentupa
An increase in cardiac output during pregnancy increases the risk of arrhythmias for the expectant mother. Supraventricular tachycardia (SVT) underlies the sensations of arrhythmia in a pregnant woman in as many as one sixth of the cases. Vagal nerve (n. vagus) stimulation and adenosine serve as first-line treatment, but electrical cardioversion is likely to be a safe alternative as well. We describe a case in which the SVT of a woman in the third trimester of pregnancy was unresponsive to vagal nerve stimulation and pharmacological treatments...
2016: Duodecim; Lääketieteellinen Aikakauskirja
https://www.readbyqxmd.com/read/26850832/myocardial-effects-of-fetal-endoscopic-tracheal-occlusion-in-lambs-with-cdh
#9
Elisa Zambaiti, Rossana Bussani, Valeria Calcaterra, Lorenzo Zandonà, Furio Silvestri, José Luis Peiró, Mario Marotta, Erika Andreatta, Gloria Pelizzo
INTRODUCTION: Fetal endoscopic tracheal occlusion in congenital diaphragmatic hernia (CDH) may reduce pulmonary hypertension and ameliorate postnatal cardiac output. The effects of sustained early (ETO) and late (LTO) tracheal occlusion on left ventricular (LV) cells in the lamb model have not been described. MATERIALS AND METHODS: CDH was created in lambs at 70 days' gestation (term = 145 days). ETO (85 days) or LTO (105 days) was sustained till term. After cesarean section (140 days) fetuses were euthanized and hearts harvested...
April 2016: Prenatal Diagnosis
https://www.readbyqxmd.com/read/26718697/non-invasive-cardiac-output-monitoring-for-cesarean-delivery-under-epidural-anesthesia-in-a-patient-with-marfan-syndrome-and-cardiomyopathy
#10
S Beaudry, J Pick, P M Heerdt
Maternal cardiac output and stroke volume increase significantly at the time of cesarean delivery. Parturients with baseline myocardial dysfunction are at increased risk of cardiovascular decompensation in the peripartum period and close hemodynamic monitoring is warranted. We report our use of intraoperative non-invasive cardiac output monitoring during cesarean delivery under epidural anesthesia in a 24-year-old woman with dilated cardiomyopathy secondary to Marfan syndrome, aortic arch, aortic valve and mitral valve replacements and a left ventricular ejection fraction of 37%...
February 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/26334607/guidelines-for-the-management-of-a-pregnant-trauma-patient
#11
Venu Jain, Radha Chari, Sharon Maslovitz, Dan Farine, Emmanuel Bujold, Robert Gagnon, Melanie Basso, Hayley Bos, Richard Brown, Stephanie Cooper, Katy Gouin, N Lynne McLeod, Savas Menticoglou, William Mundle, Christy Pylypjuk, Anne Roggensack, Frank Sanderson
OBJECTIVE: Physical trauma affects 1 in 12 pregnant women and has a major impact on maternal mortality and morbidity and on pregnancy outcome. A multidisciplinary approach is warranted to optimize outcome for both the mother and her fetus. The aim of this document is to provide the obstetric care provider with an evidence-based systematic approach to the pregnant trauma patient. OUTCOMES: Significant health and economic outcomes considered in comparing alternative practices...
June 2015: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/26168834/goal-directed-fluid-therapy-may-improve-hemodynamic-stability-of-parturient-with-hypertensive-disorders-of-pregnancy-under-combined-spinal-epidural-anesthesia-for-cesarean-delivery-and-the-well-being-of-newborns
#12
RANDOMIZED CONTROLLED TRIAL
Wei Xiao, Qing-Fang Duan, Wen-Ya Fu, Xin-Zuo Chi, Feng-Ying Wang, Da-Qing Ma, Tian-Long Wang, Lei Zhao
BACKGROUND: Hypotension induced by combined spinal epidural anesthesia in parturient with hypertensive disorders of pregnancy (HDP) can easily compromise blood supply to vital organs including uteroplacental perfusion and result in fetal distress. The aim of this study was to investigate whether the goal-directed fluid therapy (GDFT) with LiDCO rapid system can improve well-being of both HDP parturient and their babies. METHODS: Fifty-two stable HDP parturient scheduled for elective cesarean delivery were recruited...
July 20, 2015: Chinese Medical Journal
https://www.readbyqxmd.com/read/25868957/diffuse-neonatal-hemangiomatosis-in-a-very-low-birthweight-infant-treated-with-erythropoietin
#13
Takashi Okuno, Shuko Tokuriki, Tomomi Yoshino, Nanae Tanaka, Yusei Ohshima
Diffuse neonatal hemangiomatosis (DNH) is a rare condition characterized by the concomitant development of multiple cutaneous infantile hemangiomas (IH) and visceral hemangiomas. Recently, an association between erythropoietin treatment and an increased incidence of infantile hemangioma was noted. A Japanese male infant was born via cesarean section at 27 weeks of gestation. Following the commencement of erythropoietin treatment for anemia of prematurity, he developed multiple cutaneous hemangiomas, high cardiac output heart failure and hepatomegaly...
April 2015: Pediatrics International: Official Journal of the Japan Pediatric Society
https://www.readbyqxmd.com/read/25787644/-294-pos-maternal-circulating-blood-volume-and-cardiac-output-in-pregnancy-induced-hypertension
#14
Shoko Makabe, Risa Fujihara, Shintaro Makino, Katsuo Terui, Hiroyuki Seki, Atsuo Itakura, Satoru Takeda
OBJECTIVES: To document maternal hemodynamics of pregnancy induced hypertension (PIH), maternal circulating blood volume and cardiac output was evaluated. METHODS: The objects were 120 singleton pregnancies including 60 cases with PIH who underwent cesarean section during March, 2000 to April, 2007. Among 60 cases of PIH, 48 cases were classified into preeclampsia (PE) and 12 cases were classified into gestational hypertension (GH). The circulating blood volume (BV) and cardiac output (CO) were measured using the DDG analyzer just before delivery...
January 2015: Pregnancy Hypertension
https://www.readbyqxmd.com/read/25635593/randomized-double-blinded-comparison-of-norepinephrine-and-phenylephrine-for-maintenance-of-blood-pressure-during-spinal-anesthesia-for-cesarean-delivery
#15
RANDOMIZED CONTROLLED TRIAL
Warwick D Ngan Kee, Shara W Y Lee, Floria F Ng, Perpetua E Tan, Kim S Khaw
BACKGROUND: During spinal anesthesia for cesarean delivery, phenylephrine can cause reflexive decreases in maternal heart rate and cardiac output. Norepinephrine has weak β-adrenergic receptor agonist activity in addition to potent α-adrenergic receptor activity and therefore may be suitable for maintaining blood pressure with less negative effects on heart rate and cardiac output compared with phenylephrine. METHODS: In a randomized, double-blinded study, 104 healthy patients having cesarean delivery under spinal anesthesia were randomized to have systolic blood pressure maintained with a computer-controlled infusion of norepinephrine 5 μg/ml or phenylephrine 100 μg/ml...
April 2015: Anesthesiology
https://www.readbyqxmd.com/read/25586083/anesthetic-management-of-parturients-with-a-fontan-circulation-a-review-of-published-case-reports
#16
REVIEW
Mohamed Tiouririne, Duncan G de Souza, Kevin T Beers, Terrance A Yemen
Parturients with Fontan physiology provide unique and complex challenges to anesthesiologists. Such challenges include the maintenance of a perfect balance between preload, pulmonary vascular resistance, afterload, and cardiac output in a setting of a single ventricle physiology. The physiological changes of pregnancy add additional burden to an already "fragile" physiology, making the anesthetic management for labor and/or cesarean delivery even more complex. Understanding the impact of these changes on the Fontan physiology and the effect of anesthetic choices on this dyad (pregnancy-Fontan) is an imperative prior to caring for these patients...
September 2015: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/25510959/continuous-measurement-of-cardiac-output-with-the-electrical-velocimetry-method-in-patients-under-spinal-anesthesia-for-cesarean-delivery
#17
Yanhong Liu, May C M Pian-Smith, Lisa R Leffert, Rebecca D Minehart, Andrea Torri, Charles Coté, Robert M Kacmarek, Yandong Jiang
In this study, we aimed to continuously measure cardiac output (CO) with the electrical velocimetry (EV) method and characterize the hemodynamic profile of patients undergoing spinal anesthesia for elective cesarean delivery (CD), and to discuss the potential benefit of using real time CO monitoring to guide patient management. Forty-two patients scheduled for elective CD under spinal anesthesia were enrolled in this observational study. A non-invasive CO monitor incorporating the electrical velocimetry algorithm, ICON(®) (Cardiotronic(®), La Jolla, California, USA), was used to measure CO and stroke volume (SV) continuously...
October 2015: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/24401867/large-fetal-pulmonary-arteriovenous-malformation-detected-at-midtrimester-scan-with-subsequent-high-cardiac-output-syndrome-and-favorable-postnatal-outcome
#18
A Hellmund, C Berg, C Bryan, M Schneider, V Hraška, U Gembruch
Prenatal diagnosis of pulmonary arteriovenous malformations (PAVM), caused by abnormal communications between pulmonary arteries and pulmonary veins, is rarely described. We report a case of a PAVM between the right pulmonary artery and the left atrium, referred to our prenatal unit at 22 + 1 weeks of gestation, with severe cardiomegaly, dilation of the right pulmonary artery and a right pulmonary vein and retrograde flow in the ductus arteriosus. The fistula was located in the right lung and showed a broad, disturbed flow at color Doppler with high velocity and low pulsatility...
2014: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/24346112/noninvasive-measurements-of-hemodynamic-transition-directly-after-birth
#19
Jeroen J van Vonderen, Arno A W Roest, Melissa L Siew, Nico A Blom, Jan M van Lith, Frans J Walther, Stuart B Hooper, Arjan B te Pas
BACKGROUND: Cardiac output depends on stroke volume and heart rate (HR). Only HR is used to monitor hemodynamic transition. METHODS: In 24 term newborns born via cesarean section, HR and preductal blood pressure (BP) were measured. Also, using echocardiography, left ventricular dimensions and (Doppler derived) left ventricular output (LVO) were examined at 2, 5, and 10 min after birth. RESULTS: Mean (SD) HR and BP did not change with time (mean HR: 157 (21) bpm at 2 min, 154 (17) bpm at 5 min, and 155 (14) bpm at 10 min; mean BP: 51...
March 2014: Pediatric Research
https://www.readbyqxmd.com/read/24137666/changes-in-blood-pressure-and-cardiac-output-during-cesarean-delivery-the-effects-of-oxytocin-and-carbetocin-compared-with-placebo
#20
RANDOMIZED CONTROLLED TRIAL
Leiv Arne Rosseland, Tor Hugo Hauge, Guro Grindheim, Audun Stubhaug, Eldrid Langesaeter
BACKGROUND: Little is known about maternal hemodynamics after Cesarean delivery. Uterine contractions may increase cardiac output. Oxytocin is the first-line treatment for uterine atony, although the effects of the long-acting oxytocin analogue carbetocin are comparable with that of oxytocin. The authors analyzed the effects of i.v. oxytocin 5 U, carbetocin 100 μg, and placebo on hemodynamics, uterine tone, adverse events, and blood loss after Cesarean delivery. METHODS: This was a randomized, double-blinded, placebocontrolled, parallel-group comparison of carbetocin and oxytocin after elective Cesarean delivery of singletons under spinal anesthesia (n = 76)...
September 2013: Anesthesiology
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