Appropriate delivery method for cardiac disease pregnancy based on noninvasive cardiac monitoring
-
Masami Sawada
,
Jun Yoshimatsuj
Abstract
Background
There are numerous significant physiological changes occurring in circulation during labor. To detect these rapid hemodynamic changes, invasive and intermittent measurement techniques are not reliable. To suggest a suitable delivery method for pregnancy with cardiac disease, this study analyzed how each delivery method influences cardiac function using a noninvasive and continuous measurement technique.
Methods
A prospective study was accomplished at the National Cerebral and Cardiovascular Center in Japan from October 1, 2014, to November 30, 2018. The classification of the healthy heart pregnant women was according to the delivery method: vaginal delivery (VD) without epidural anesthesia, VD with epidural anesthesia, and caesarean section (CS). The hemodynamic parameters cardiac index (CI), stroke volume index (SI), and heart rate (HR) were evaluated regularly throughout delivery by noninvasive electrical cardiometry monitor.
Results
Ten cases were examined for each group. CI and HR were significantly increased before VD, while the increase in CI and HR was mild in the epidural group in comparison to the nonepidural group. SI was increased toward the delivery in the epidural group, and it was constant in the nonepidural group. However, there was no alteration in the level of outcomes of the two groups. In CS, SI increased and HR decreased before delivery. After delivery, SI continued to increase, while HR did not change but CI increased.
Conclusion
In VD, the increase in venous circulation according to the autotransfusion is managed by increasing HR. By epidural anesthesia, the increase in HR was suppressed and SI was increased. However, as epidural anesthesia increases the vascular capacity, the level of SI outcome was comparable. In CS, the HR was decreased because of the spinal anesthesia and the SI was increased because of many factors like hydration. As there are many factors to control in CS, VD with epidural anesthesia will be the first preference for most cardiac patients.
Acknowledgments
We are grateful to Prof Dr. Ohmichi and Dr. Fujita for helpful discussions and comments on the manuscript.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
The institution where the study was conducted: National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
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©2020 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Editorial
- Women and children first: the need for ringfencing during the COVID-19 pandemic
- Review
- The decline of amniocentesis and the increase of chorionic villus sampling in modern perinatal medicine
- Original Articles – Obstetrics
- Fetal renal artery impedance in pregnancies affected by preeclampsia
- The effect of maternal position on fetal middle cerebral artery Doppler indices and its association with adverse perinatal outcomes: a pilot study
- Interpregnancy interval and the risk for recurrence of placental mediated pregnancy complications
- Short- and long-term outcomes of preterm spontaneous twin anemia-polycythemia sequence
- How do sustained birth tears after vaginal birth affect birth tear patterns in a subsequent birth?
- Disorders of placental villous maturation in fetal death
- Atrial septal aneurysm in pregnancy: echocardiography and obstetric outcomes
- Appropriate delivery method for cardiac disease pregnancy based on noninvasive cardiac monitoring
- Original Articles – Fetus
- Success rate of five fetal cardiac views using HDlive Flow with spatiotemporal image correlation at 18–21 and 28–31 weeks of gestation
- Fetal brain development in small-for-gestational age (SGA) fetuses and normal controls
- Can fetal fractions in the cell-free DNA test predict the onset of fetal growth restriction?
- Original Articles – Newborns
- Presence of neonatal intensive care services at birth hospital and early intervention enrollment in infants ≤1500 g
- The contribution of twins conceived by in vitro fertilization to preterm birth rate: observations from a quarter of century
- Burnout in neonatal intensive care unit nurses: relationships with moral distress, adult attachment insecurities, and proneness to guilt and shame
Articles in the same Issue
- Frontmatter
- Editorial
- Women and children first: the need for ringfencing during the COVID-19 pandemic
- Review
- The decline of amniocentesis and the increase of chorionic villus sampling in modern perinatal medicine
- Original Articles – Obstetrics
- Fetal renal artery impedance in pregnancies affected by preeclampsia
- The effect of maternal position on fetal middle cerebral artery Doppler indices and its association with adverse perinatal outcomes: a pilot study
- Interpregnancy interval and the risk for recurrence of placental mediated pregnancy complications
- Short- and long-term outcomes of preterm spontaneous twin anemia-polycythemia sequence
- How do sustained birth tears after vaginal birth affect birth tear patterns in a subsequent birth?
- Disorders of placental villous maturation in fetal death
- Atrial septal aneurysm in pregnancy: echocardiography and obstetric outcomes
- Appropriate delivery method for cardiac disease pregnancy based on noninvasive cardiac monitoring
- Original Articles – Fetus
- Success rate of five fetal cardiac views using HDlive Flow with spatiotemporal image correlation at 18–21 and 28–31 weeks of gestation
- Fetal brain development in small-for-gestational age (SGA) fetuses and normal controls
- Can fetal fractions in the cell-free DNA test predict the onset of fetal growth restriction?
- Original Articles – Newborns
- Presence of neonatal intensive care services at birth hospital and early intervention enrollment in infants ≤1500 g
- The contribution of twins conceived by in vitro fertilization to preterm birth rate: observations from a quarter of century
- Burnout in neonatal intensive care unit nurses: relationships with moral distress, adult attachment insecurities, and proneness to guilt and shame
