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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

Inferior Vena Cava Assessment in Term Pregnancy using Ultrasound: A Feasibility Study of the Subxiphoid and Right Upper Quadrant Views

Abstract Number: S4A-1
Abstract Type: Original Research

Fatemah Qasem MBBCh, MD1 ; Fatemah Qasem MBBCh, MD2; Ahmed Hegazy MD, FRCPC3; John Fuller MD, FRCPC4; Ronit Lavi MD,FRCPC5; Indu Singh MD, FRCPC6

Introduction: Point-of-care ultrasound is non-invasive, safe, expedient, and can be employed in a variety of acute care settings. Previous studies, demonstrated how views from the apical and parasternal windows are readily obtainable in laboring parturients.(1,2) The subxiphoid window however, may be challenging in these patients due to uterine enlargement. Our study hypothesis is that in term parturients, the inferior vena cava is more readily visible on ultrasound from the Right Upper Quadrant(RUQ) compared to the subxiphoid (SX) window.

Methods: A convenience sample of 30 term, pregnant, non-laboring women were consented and recruited. One anesthesiologist, experienced with ultrasound, performed scans of the RUQ view starting in the mid-axillary line at the 4th intercostal space, looking to obtain a view of the IVC as it enters the right atrium (RA). Following successful acquisition, the examiner performed a scan from the subxiphoid position, looking to obtain the same view of the IVC transitioning into the RA. Primary outcome was the time required to obtain an image by the examiner. Another investigator witnessing the examination used a stopwatch to time the acquisition of images. If the duration of scanning exceeded ten minutes, the scan was discontinued and labeled as failed. Each acquired image was reviewed independently by 2 different investigators with extensive ultrasound experience.

Results: There was a significant difference in the time (seconds) required to obtain each view; subxiphoid median (IQR): 52(35, 59), right upper quadrant median (IQR): 23(11, 55)(p-value=0.0045). Adequate quality images, rated by the independent reviewers, were acquired significantly more often in the RUQ window compared to the SX window (Table 1). Ease of obtaining the view by the operator, was rated significantly easier in the RUQ window compared to the SX window (p-value < 0.0001). All patients participating in the study reported good tolerance for the scanning (100%) and all stated they were comfortable during scan performance.

Conclusion: IVC visualization in pregnant patients takes less time, is easier, and consistently provides better quality images in the RUQ window compared to the SX window.

References:

1. Pros. observ. study of serial cardiac output by TTE in healthy pregnant women undergoing elective caesarean delivery A.Dennis, etal, IJOA(2010)19,142–148

2. TTE in obstetric anaesthesia and obstetric critical illness, A.T. Dennis, IJOA(2011)20,160–168



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