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Continuous transthoracic echocardiographic monitoring for changes in maternal cardiac hemodynamics during cesarean section under combined epidural–spinal anesthesia: a prospective, observational study

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Abstract

The change in maternal hemodynamics during cesarean section has not been well studied. Continuous transthoracic echocardiography can monitor cardiac function continuously. This study aimed to evaluate the effectiveness of maternal hemodynamic parameters monitoring during cesarean section using continuous transthoracic echocardiography. In this prospective, observational study, women with an uncomplicated singleton pregnancy scheduled for elective cesarean section at term under combined spinal–epidural anesthesia were enrolled. Maternal hemodynamic parameters were assessed by continuous transthoracic echocardiography at 11 pre-set time points. The image quality of continuous transthoracic echocardiography was evaluated before measurement was performed. Totally, one hundred parturients were recruited, and transthoracic echocardiography images with sufficient quality for further analysis were obtained in 72 women. Following anesthesia, maternal heart rate decreased by 11.18% and cardiac output decreased by 7.82%, but stroke volume remained stable. After delivery of the neonate and placenta, stroke volume and cardiac output increased by 21.09% and 22.33%, respectively. End-diastolic volume also increased significantly after delivery of the neonate, but end-systolic volume was unchanged. Following delivery of the neonate, fractional shortening increased till the end of the cesarean section while total peripheral resistance decreased significantly. In conclusion, continuous transthoracic echocardiographic monitoring revealed that there were significant changes in hemodynamic parameters during cesarean section after delivery of the newborn and placenta, which warranted further investigation.

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Acknowledgements

We thank Ellen Knapp, PhD, from Liwen Bianji, Edanz Group China (www.liwenbianji.cn/ac), for improving the scientific English writing of this manuscript.

Funding

Dr. Han Huang received funding support from Chengdu Bureau of Science and Technology (2019-YFYF-00108-SN).

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Author notes

  1. Zhimin Liao and Shimiao Feng are joint first authors and contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, 20#, 3rd Segment, Ren Min Nan Lu, Chengdu, 610041, Sichuan, People’s Republic of China

    Zhimin Liao, Shimiao Feng & Han Huang

  2. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Haibo Song

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  1. Zhimin Liao
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  4. Han Huang
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Correspondence to Han Huang.

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Approved by the ethics committee of West china hospital of Sichuan university (2013(201)).

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Written informed consent was obtained from all parturients before enrollment.

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Patients signed informed consent regarding publishing their data.

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Liao, Z., Feng, S., Song, H. et al. Continuous transthoracic echocardiographic monitoring for changes in maternal cardiac hemodynamics during cesarean section under combined epidural–spinal anesthesia: a prospective, observational study. J Clin Monit Comput 36, 1387–1396 (2022). https://doi.org/10.1007/s10877-021-00777-y

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  • DOI: https://doi.org/10.1007/s10877-021-00777-y

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