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Assessement of Hemodynamic Changes Associated With Uterine Displacement Using Noninvasive Cardiac Output Monitoring and Transthoracic Echocardiography: (LUDCO)
Abstract Number: SAT-46
Abstract Type: Original Research
Introduction: Cardiac arrest during pregnancy occurs in approximately 1:12,000 hospital admissions (1), with significant maternal and fetal morbidity and mortality. The gravid uterus decreases cardiac preload by aortocaval compression (ACC) and improvements in ejection fraction, stroke volume, and cardiac output have been documented with left lateral decubitus position. Three methods of uterine displacement are recommended in the 2015 AHA Scientific Statement on Cardiac Arrest in Pregnancy, however, their hemodynamic impact has not been directly compared. We hypothesized that the use of left uterine displacement, when compared to the supine positioning with uterine displacement by pushing or pulling, would offer the optimal alterations in pregnant cardiac hemodynamics when measured by echocardiography and non-invasive cardiac output monitoring (NICOM).
Methods: Following IRB approval and informed consent, non-laboring pregnant women scheduled for elective cesarean delivery were enrolled. Exclusion criteria include patient refusal, NPO status, cardiovascular disease (chronic or gestational hypertension, pre-eclampsia, congenital heart disease), cerebral vascular disease (stroke, aneurysm), and multiple gestation. With the NICOM attached and the echocardiographer blinded to the measurements, the three uterine displacement maneuvers were produced. Velocity time integral (VTI) heart rate (HR), and cardiac output (CO) was recorded. The left ventricular outflow tract diameter was measured.
Results: To date, 12/25 patients have enrolled and completed their participation. With LLD considered to be the standard comparator, uterine pushing, versus pulling, provided consistently better maternal hemodynamics. NICOM consistently provided lower CO and CI values.
Conclusions: When compared to LLD, uterine pushing was better than pulling in preserving maternal hemodynamics. Cardiac output was different between two forms of monitors (TTE and NICOM), but consistent trends were observed. The data presents valuable insight into the hemodynamic changes associated with manual left uterine displacement in a pregnant patient, particularly in the setting of cardiac arrest. Additional investigation is necessary.
1. Lipman et al. Anesth Analg 2014;188:1003-1016
2. Bamber et al. Anesth Analg 2003;97:256-8.