title: [Effect of intra-abdominal pressure in pregnant women on level of spina block and frequency of hypotension during cesarean section].
abstract: BACKGROUND
  It is common knowledge that an increase of intra-abdomninal pressure (lAP) causes a decrease in the volume of cerebrospinal fluid in the lumbar and lower thoracic region, which may contribute to the development of more high spinal block. There is currently no research devoted to studying the impact of intra-abdominal pressure in pregnancy on the development of high spinal blockade.
  
  
  OBJECTIVE
  To investigate effects of intra-abdominal pressure in pregnancy on the development of spinal blockade and incidence of hypotension during cesarean section.
  
  
  METHODS
  170 pregnant women with gestational age 38-40 weeks were included in the randomized, blinded, controlled study. All the women received elective cesarean section under spinal anesthesia (SA). Pregnant women w|,ere divided into two groups of 85 females each. In the first group, the anesthesiologist did not know the value of lAP and used the dose of local anesthetic focusing on height, weight, and according to his own experience. In the second group, an anesthesiologist corrected dose of local anesthetic depending on the lAP and also considered the height and weight of a woman.
  
  
  RESULTS
  In 9.2% of women, lAP was less than 11 mmHg (physiologically normal), in 49%--from 12 to 15 mmHg (degree I of intra-abdominal hypertension (IAH)), in 40.3%--from 16 to 20 mmHg (degree II of IAH), in 1.5%--from 21 to 25 mmHg (degree III of IAH). In the first group, the incidence of high spinal block (above Th4) and incidence of arterial hypotension (systolic blood pressure under 90 mm.Hg) was two times higher than in the second group (p<0.01).
  
  
  CONCLUSIONS
  Intra-abdominal hypertension in pregnant women contributed to the development of high spinal block and hypotension. To prevent these complications, we recommend decreasing the dose of local anesthetic with use of the Scale of the Risk of developing high spinal block in pregnant.
authors.forename: A M
authors.initials: AM
authors.lastname: Ronenson
authors.forename: S I
authors.initials: SI
authors.lastname: Sitkin
authors.forename: Iu V
authors.initials: IuV
authors.lastname: Savel'eva
mesh_terms: D005260:Female; D006801:Humans; D011247:Pregnancy; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage; D001794:Blood Pressure / Q000502:physiology; D001835:Body Weight; D002045:Bupivacaine / Q000008:administration & dosage; D002585:Cesarean Section; D003627:Data Interpretation, Statistical; D004305:Dose-Response Relationship, Drug; D007022:Hypotension / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D059325:Intra-Abdominal Hypertension / Q000150:complications / Q000503:physiopathology; D009765:Obesity / Q000503:physiopathology; D011248:Pregnancy Complications / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D016037:Single-Blind Method
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine