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The Use of Fetal Monitor Belt Position to Determine Lumbar Vertebral Level in the Parturient
Abstract Number: S 21
Abstract Type: Original Research
Introduction: Tuffier’s line, which is the imaginary line drawn between the superior aspects of the iliac crests, has classically been used as a marker for the L4-5 interspace. Many authors have demonstrated a lack of accuracy using Tuffier’s line as an anatomical landmark. (1,2). Thus, an alternative method for determining the intervertebral space is warranted. Owing to the inaccuracy of the palpation technique, we sought to determine if the skin marking left by the fetal monitor belt could serve as a reliable surrogate marker for vertebral space determination.
Methods: After IRB approval and verbal consent, 30 laboring parturients requesting epidural analgesia at term gestation were enrolled. With the woman in the sitting position, and after removal of the fetal monitor belt, the transducer belt skin marking was identified and marked. Lumbar ultrasonography was then performed using the Sonosite M-Turbo Ultrasound System with a C60x 5-2MHz curvilinear probe. The vertebral interspace corresponding to the belt location was noted. Demographic data including age, height, weight, BMI, parity, and gestational age was recorded.
Results: Fetal monitor belt location as determined by ultrasonography is displayed in Figure 1. The L2-3 interspace was the most common intervertebral space identified (46%). A non-significant trend towards a more caudal transducer belt location with increasing BMI, and vice-versa, was observed.
Conclusion: Transducer belt location may be an adjunct to palpation of the iliac crests prior to obstetric neuraxial anesthesia. Repeated palpation of the iliac crests can result in patient discomfort. (3) Thus, utilization of this simple and novel tool may decrease pre- and intra-procedure examination time and discomfort, especially in those patients in whom palpation of the iliac crests is difficult or repeated attempts at epidural catheter placement are needed.
Kettani A, et al. Evaluation of the iliac crest as anatomic landmark for spinal anaesthesia in pregnant women. Ann Fr Anesth Reanim 2006; 25: 501-4.
Margarido C, et al. The intercristal line determined by palpation is not a reliable anatomical landmark for neuraxial anesthesia. Can J Anesth 2011; 58: 262-266.
McDonald S, et al. See one, do one, teach one, have one: A novel variation on regional anesthesia training. Reg Anesth Pain Med 2002; 27: 456-59.