Impact of maternal lateral tilt on cardiac output during caesarean section under spinal anaesthesia: a prospective observational study

Chiara Sonnino, Luciano Frassanito, Alessandra Piersanti, Pietro Paolo Giuri, Bruno Antonio Zanfini, Stefano Catarci, Gaetano Draisci, Chiara Sonnino, Luciano Frassanito, Alessandra Piersanti, Pietro Paolo Giuri, Bruno Antonio Zanfini, Stefano Catarci, Gaetano Draisci

Abstract

Background: Left uterine displacement (LUD) has been questioned as an effective strategy to prevent aortocaval compression after spinal anesthesia (SA) for cesarean delivery (CD). We tested if LUD has a significant impact on cardiac output (CO) in patients undergoing CD under SA during continuous non-invasive hemodynamic monitoring with Clearsight.

Methods: Forty-six patients were included in the final analysis. We considered 4 timepoints of 5 min each: T1 = baseline with LUD; T2 = baseline without LUD; T3 = after SA with LUD; T4 = after SA without LUD. LUD was then repositioned for CD. The primary outcome was to assess if CO decreased from T3 to T4 of at least 1.0 L/min. We also compared CO between T1 and T2 and other hemodynamic variables: mean, systolic and diastolic blood pressure (respectively MAP, SAP and DAP), heart rate (HR), stroke volume (SV), stroke volume variation (SVV), pulse pressure variation (PPV), contractility (dP/dt), dynamic arterial elastance (Eadyn) at the different timepoints. Data on fetal Apgar scores and umbilical arterial and venous pH were collected.

Results: CO did not vary from T3 to T4 (CO mean difference -0.02 L/min [95% CI -0.88 to 0.82; P = 1). No significant variation was registered for any variable at any timepoint.

Conclusions: LUD did not show a significant impact on CO during continuous hemodynamic monitoring after SA for CD.

Trial registration: (retrospectively registered on 03/12/2021) NCT05143684 .

Keywords: Cardiac output; Cesarean delivery; Left uterine displacement; Noninvasive hemodynamic monitoring; Spinal anesthesia.

Conflict of interest statement

Dr Sonnino, Piersanti, Giuri, Zanfini, Catarci and Professor Draisci have no competing interests to declare. Dr Frassanito received an honorarium from Edwards Lifesciences Ltd for scientific advice. All other authors have no conflicts of interest to disclose.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Description of timepoints for comparison of hemodynamic variables. V: vena cava; A: aorta; LUD: left uterine displacement; SA: spinal anesthesia. R = right; L = left
Fig. 2
Fig. 2
Consort diagram
Fig. 3
Fig. 3
Mean values of CO at the single timepoints in ml/min. CO = cardiac output. T1 = baseline with left uterine displacement (LUD); T2 = baseline without LUD; T3 = after spinal anesthesia (SA) with LUD; T4 = after SA without LUD
Fig. 4
Fig. 4
Mean values of main hemodynamic variables at the single timepoints: T1 = baseline with left uterine displacement (LUD); T2 = baseline without LUD; T3 = after spinal anesthesia (SA) with LUD; T4 = after SA without LUD. SAP = systolic arterial pressure; MAP = mean arterial pressure; DAP = diastolic arterial pressure; HR = heart rate ; SV = stroke volume; SVV = stroke volume variation; PPV: pulse pressure variations; dP/dt: contractility in mmHg/sec; Eadyn = dynamic elastance

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