Maternal and uteroplacental haemodynamic state in pre-eclamptic patients during spinal anaesthesia for Caesarean section |
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Authors: | Karinen J; Rasanen J; Alahuhta S; Jouppila R; Jouppila P |
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Institution: | Department of Anaesthesia, Oulu University Hospital, Kajaanintie 52A, FIN- 90220 Oulu, Finland; Department of Obstetrics and Gynaecology, Oulu University Hospital, Kajaanintie 52A, FIN-90220 Oulu, Finland |
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Abstract: | We have studied the effects of crystalloid (Ringer's acetate 1 litre)
preloading and subsequent spinal anaesthesia in 12 pre-eclamptic parturient
patients undergoing elective Caesarean section. Maternal placental uterine
artery circulation was measured using a pulsed colour Doppler technique
with simultaneous measurement of maternal haemodynamic state. Despite
preloading, mean maternal systolic arterial pressure (SAP) decreased
significantly and marked maternal hypotension (SAP < 80% of baseline
value) was recorded in two patients after induction of spinal anaesthesia.
Mean central venous pressure increased significantly after preload, but
decreased to baseline shortly after induction of spinal anaesthesia. Mean
pulsatility index (PI) in the uterine artery did not change during preload
or spinal block. In one patient, uterine artery PI increased significantly
when SAP decreased to 71% of the baseline value, 14 min after induction of
spinal anaesthesia. These results suggest that preload with crystalloid
solution does not prevent maternal hypotension in pre-eclamptic patients,
and that changes in uterine artery velocity waveforms were minor when SAP
was 80% or more of baseline during spinal anaesthesia. These changes did
not appear to have any major effect on the clinical condition of the
neonate, as assessed by Apgar score and umbilical artery pH values.
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