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Neuraxial Analgesia Does Not Alter Cerebrovascular Hemodynamics In Laboring Women With Preeclampsia
Abstract Number: O2 4
Abstract Type: Original Research
Hypertensive diseases of pregnancy have been associated with catastrophic cerebrovascular consequences and death, likely related to disturbances of normal cerebral hemodynamics. Data is limited regarding the effects of neuraxial anesthetic techniques on cerebral hemodynamics. In this study, transcranial Doppler ultrasound (TCD) was used to estimate these effects in laboring women with preeclampsia.
In this prospective cohort study of pregnant women, we performed power M-mode maternal transcranial Doppler (TCD) assessment of the middle cerebral artery (MCA) on women with preeclampsia who received neuraxial labor analgesia (epidural and combined spinal-epidural techniques) and compared them to healthy control subjects. TCD assessments were made prior to and at 30, 60, and 120 minutes after initiation of neuraxial analgesia. Systolic (PSV) and diastolic (MDV) velocities, pulsatility (PI) and resistance (RI) indices, along with resistance-area-product (RAP), cerebral flow index (CFI), and cerebral perfusion pressure (CPP) were calculated. Analysis was performed using Fisher’s exact, student t-test, and repeated measures ANOVA.
A total of 43 cases were enrolled and underwent maternal MCA TCD examination. Maternal demographics did not differ between the two groups. When compared to controls (n=35), women with preeclampsia (n=8) had higher baseline (systolic & diastolic) blood pressure (143 + 23 vs. 120 + 13 mmHg, p=0.002), and lower heart rates (70 + 26 vs. 82 +12 beats per minute, p=0.04). Although women with preeclampsia demonstrated higher CPP (62.2 + 15.6 vs. 57.4 + 12.9 mmHg, p=0.9) and lower CFI (34.8 + 11.8 vs. 38.3 + 11.7, p=0.9), overall, neuraxial anesthesia administration was not associated with any significant intra or inter-group changes in the cerebral resistance indices, flow index, perfusion pressure, or maternal autoregulation indices.
Neuraxial anesthesia during labor does not appear to alter cerebral hemodynamics in women with preeclampsia nor their normotensive healthy counterparts. Future studies are needed in high risk pregnancies with potential intracerebral vasculopathy.
Belfort MA, Varner MW, Dizon-Townson DS, et al. Cerebral perfusion pressure, and not cerebral blood flow, may be the critical determinant of intracranial injury in preeclampsia: a new hypothesis. Am J Obstet Gynecol 2002; 187: 626-34.
Belfort MA, Allred J, and Dildy G. Magnesium sulfate decreases cerebral perfusion pressure in preeclampsia. Hypertension in Pregnancy 2008; 27: 315-327.