Abstract
Purpose
Hypotension due to spinal anesthesia is a well-known side effect in pregnant women receiving caesarean section. Little is known about its impact on fetal blood circulation.
Methods
40 women with uncomplicated singleton term pregnancies prepared for caesarean section were prospectively evaluated by Doppler sonography before and immediately after spinal anesthesia.
Results
In 90% of the women, blood pressure significantly decreased after spinal anesthesia and 42.5% of the patients suffered from severe hypotension. We found a significant negative correlation between maternal blood pressure change and the resistant index (RI) of the umbilical artery (rs = − 0.376, p = 0.017) and a significant positive correlation between maternal blood pressure and fetal middle cerebral artery.
Conclusion
Healthy fetuses seem to compensate well in situations with decreased uteroplacental blood flow due to maternal hypotension measured by means of RI changes in the fetal umbilical and middle cerebral artery. This raises the question if growth-restricted and/or preterm fetuses are able to compensate similarly or if general anesthesia would be a method of choice.
Similar content being viewed by others
References
Barber EL, Lundsberg LS, Belanger K et al (2011) Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol 118:29–38. https://doi.org/10.1097/AOG.0b013e31821e5f65
No title. https://www.destatis.de/DE/ZahlenFakten/GesellschaftStaat/Gesundheit/Krankenhaeuser/Tabellen/KrankenhausentbindeungenKaiserschnitt.html. Accessed 20 July 2017
Kowalcek I, Hainer F (2012) Is there a relation between maternal age and preferred mode of delivery? J Clin Gynecol Obstet 1:4–9. doi:https://doi.org/10.4021/jcgo3e
Sumikura H, Niwa H, Sato M et al (2016) Rethinking general anesthesia for cesarean section. J Anesth 30:268–273. doi:https://doi.org/10.1007/s00540-015-2099-4
Mercier FJ, Augè M, Hoffmann C et al (2013) Maternal hypotension during spinal anesthesia for caesarean delivery. Minerva Anestesiol 79:62–73
Cyna AM, Andrew M, Emmett RS et al (2006) Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. doi:https://doi.org/10.1002/14651858.CD002251.pub2
Reynolds F, Seed PT (2005) Anaesthesia for caesarean section and neonatal acid-base status : a meta-analysis. Anaesthesia 60(7):636–653. https://doi.org/10.1111/j.1365-2044.2005.04223.x
Strouch ZY, Dakik CG, White WD, Habib AS (2015) Anesthetic technique for cesarean delivery and neonatal acid-base status: a retrospective database analysis. Int J Obs Anesth 24:22–29. doi:https://doi.org/10.1016/j.ijoa.2014.11.002
Reuwer PJ, Sijmons EA, Rietman GW et al (1987) Intrauterine growth retardation: prediction of perinatal distress by Doppler ultrasound. Lancet (Lond, Engl) 2:415–418
Schneider KTM, Deckardt R, Rust M et al (1991) Dopplerflußverhalten in mütterlichen und fetalen Gefäßen vor und während Periduralanästhesie. Geburtsh u Frauenheilk 51:544–548
Fairlie FM, Kirkwood I, Lang GD, Sheldon CD (1991) Umbilical artery flow velocity waveforms during spinal anesthesia. Eur J Obstet Gynecol Reprod Biol 38:3–7
Tercanli S, Schneider M, Visca E, Hösli I, Troeger C, Peukert R, Holzgreve W (2002) Influence of volume preloading on uteroplacental and fetal circulation during spinal anaesthesia for caesarean section in uncomplicated singleton pregnancies. Fetal Diagn Ther 17(3):142–146
Watson PT, Young WP, Hegge FN (1987) Doppler measurements of maternal and fetal blood flow. Clin Obstet Gynecol 30:948–955
Banerjee A, Stocche RM, Angle P, Halpern SH (2010) Preload or coload for spinal anesthesia for elective Cesarean delivery: a meta-analysis. Can J Anaesth 57:24–31. doi:https://doi.org/10.1097/01.aoa.0000397126.35332.37
Mitra JK, Roy J, Bhattacharyya P et al (2013) Changing trends in the management of hypotension following spinal anesthesia in cesarean section. J Postgrad Med 59:121–126. doi:https://doi.org/10.4103/0022-3859.113840
Karinen J, Räsänen J, Alahuhta S et al (1995) Effect of crystalloid and colloid preloading on uteroplacental and maternal haemodynamic state during spinal anaesthesia for caesarean section. Br J Anaesth 75:531–535
Robson SC, Samsoon G, Boys RJ et al (1993) Incremental spinal anaesthesia for elective caesarean section: maternal and fetal haemodynamic effects. Br J Anaesth 70:634–638
Alfirevic Z, Stampalija T, Medley N (2015) Fetal and umbilical Doppler ultrasound in normal pregnancy. Cochrane Database Syst Rev. doi:https://doi.org/10.1002/14651858.CD001450.pub4
Khatib N, Weiner Z, Beloosesky R et al (2014) The effect of maternal supine position on umbilical and cerebral blood flow indices. Eur J Obstet Gynecol Reprod Biol 175:112–114. doi:https://doi.org/10.1016/j.ejogrb.2013.12.043
van Katwijk C, Wladimiroff JW (1991) Effect of maternal posture on the umbilical artery flow velocity waveform. Ultrasound Med Biol 17:683–685
Kinsella SM, Lee A, Spencer JAD (1990) Maternal and fetal effects of the supine and pelvic tilt positions in late pregnancy. Eur J Obstet Gynecol Reprod Biol 36:11–17
Campbell S, Pearce JM, Hackett G et al (1986) Qualitative assessment of uteroplacental blood flow: early screening test for high-risk pregnancies. Obstet Gynecol 68:649–653
Lie KK, Grøholt E-K, Eskild A (2010) Association of cerebral palsy with Apgar score in low and normal birthweight infants: population based cohort study. BMJ 341:c4990. doi:https://doi.org/10.1136/bmj.c4990
Jain K, Bhardwaj N, Sharma A et al (2012) A randomised comparison of the effects of low-dose spinal or general anaesthesia on umbilical cord blood gases during caesarean delivery of growth-restricted foetuses with impaired Doppler flow. Eur J Anaesthesiol. doi:https://doi.org/10.1097/EJA.0b013e3283564698
Chooi C, Cox JJ, Lumb RS et al (2017) Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. doi:https://doi.org/10.1002/14651858.CD002251.PUB3
Nag DS, Samaddar DP (2015) Vasopressors in obstetric anesthesia: a current perspective. World J Clin Cases 3:58–65. doi:https://doi.org/10.12998/wjcc.v3.i1.58
Author information
Authors and Affiliations
Contributions
KL project development, data collection, investigation, data analysis, and manuscript writing. IB project development, data collection, investigation, data analysis, and manuscript writing. PW data collection, supervision and manuscript review. TWPF data analysis, statistical analysis, and manuscript review. WJ data analysis and manuscript review. FR data analysis and manuscript review. GF project development, data collection, manuscript writing, and manuscript review. UFH project development, data collection, and manuscript review.
Corresponding author
Ethics declarations
Funding
There was no funding for this study.
Conflict of interest
The authors declare no conflicts of interest.
Ethical approval
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Lato, K., Bekes, I., Widschwendter, P. et al. Hypotension due to spinal anesthesia influences fetal circulation in primary caesarean sections. Arch Gynecol Obstet 297, 667–674 (2018). https://doi.org/10.1007/s00404-017-4641-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-017-4641-0