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Pre-Contraction Maternal Tachycardia: A Noninvasive Measure of Hemodynamics in Labor
Abstract Number: T3A-3
Abstract Type: Original Research
Introduction: Hypotension among women in active labor can occur for various reasons, such as active bleeding or epidural pain relief with blunting of pain-related catecholamines. A pattern of pre-contraction maternal tachycardia (PCMT) has been described in a patient with cardiac disease, yet the prevalence of PCMT in laboring patients and its clinical significance is unknown (1). The purpose of this study is to describe the prevalence of this finding and compare hemodynamics and outcomes among women with and without PCMT after epidural placement.
Methods: From December 2017, patients receiving epidural analgesia had concurrent pulse oximetry for maternal heart rate (MHR) and uterine tocometry recorded on the GE Corometrics™ 250cx Series monitor. Pain relief after epidural placement was confirmed to eliminate pain-related MHR changes. We defined PCMT as an increase in MHR ≥ 20 bpm preceding 3 consecutive uterine contractions. The primary outcome was incidence of hypotension (≥ 20% reduction in SBP or DBP) 1 hour after epidural placement. We used univariate analysis to compare fluid administration, vasopressor therapy, fetal heart rate category, and mode of delivery according to the presence of PCMT.
Results: Thirty-four of 104 patients have been analyzed (Table). PCMT was seen in 17 of 34 (50%). Incidence of hypotension 1h after epidural placement was 58.8% and 47.1% in the PCMT vs. no PCMT groups, respectively (p =0.49). There was no difference in mode of delivery or vasopressor requirement in the PCMT vs no PCMT groups. However, with a rate of cesarean delivery of 29.4% in the PCMT group compared to 11.8% in those without the finding, 64 patients would be required in each arm to have 80% power to detect a difference between groups (two-sided alpha 0.05).
Discussion: Determination of a noninvasive tool for early detection of compromised maternal venous return in laboring parturients is of clinical relevance. Because uteroplacental blood flow lacks autoregulation, impaired maternal venous return may compromise uteroplacental perfusion through the course of labor. Our preliminary findings suggest that PCMT during labor is common and may be associated with an increased rate of cesarean delivery, but further patient recruitment is needed. Detection of PCMT as a pattern may prompt early intervention to optimize maternal hemodynamics, placental blood flow and resuscitation strategies.
1. Baird EJ and Arkoosh VA.Anesthesiology Oct 2012; 117(4):879