Maternal haemodynamics in pre-eclampsia compared with normal pregnancy during caesarean delivery.
OBJECTIVE
To determine how pre-eclampsia modifies maternal haemodynamics during caesarean delivery.


METHODS
Prospective study.


METHODS
Tampere University Hospital, Finland.


METHODS
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.


METHODS
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.
Tihtonen
K
K
Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland. kati.tihtonen@fimnet.fi
Kööbi
T
T
Yli-Hankala
A
A
Huhtala
H
H
Uotila
J
J
D000328:Adult; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D001794:Blood Pressure / Q000502:physiology*; D002307:Cardiography, Impedance; D002585:Cesarean Section; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D011225:Pre-Eclampsia / Q000503:physiopathology*; D011247:Pregnancy; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology*