Role of IVC collapsibility index to predict post spinal hypotension in pregnant women undergoing caesarean section. An observational trial

Yudhyavir Singh, Rahul K Anand, Stuti Gupta, Sumit Roy Chowdhury, Souvik Maitra, Dalim K Baidya, Akhil K Singh, Yudhyavir Singh, Rahul K Anand, Stuti Gupta, Sumit Roy Chowdhury, Souvik Maitra, Dalim K Baidya, Akhil K Singh

Abstract

Background: Postspinal anesthesia hypotension (PSH) in pregnant women is common and may lead to poor maternal and fetal outcome. Fluid loading in pregnant women before spinal anesthesia to prevent hypotension is of limited ability. We hypothesized that those women who are hypovolemic before spinal anesthesia may be at risk of PSH and inferior vena cava collapsibility index (IVCCI) will be able to identify hypovolemic parturients.

Methods: In this prospective observational study, n = 45 women undergoing elective lower segment cesarean section with singleton pregnancy were recruited and IVCCI in left lateral tilt (with wedge) and supine position (without wedge) were noted by M-mode ultrasound (USG) before spinal anesthesia. After spinal anesthesia, changes in blood pressure were noted till 15 min after spinal anesthesia.

Results: USG measurements were obtained in 40 patients and 23 of 40 patients (57.5%) had at least one episode of hypotension. Area under the ROC curve of IVCCI with wedge to predict PSH was 0.46 (95% CI 0.27, 0.64) and best cut-of value was 25.64 with a sensitivity and specificity of 60.9% and 35.5%, respectively. Area under the ROC curve of IVCCI without wedge to predict PSH was 0.38 (95% CI 0.19, 0.56) and best cut-of value was 20.4 with a sensitivity and specificity of 69.6% and 23.5%, respectively.

Conclusion: We conclude that IVCCI is not a predictor of PSH in pregnant women undergoing elective cesarean section.

Keywords: C- section; IVC collapsibility index; hemodynamic monitoring; post spinal hypotension; volume responsiveness.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2019 Saudi Journal of Anesthesia.

Figures

Figure 1
Figure 1
Ultrasound image (upper- 2D image, lower- M- mode) of IVC showing end-inspiratory and end-expiratory diameter
Figure 2
Figure 2
Dot plot showing distribution of IVCdmax (left) and IVCdmin (right) with wedge (left lateral tilt) and without wedge (supine) position
Figure 3
Figure 3
Receiver operating characteristics curve of IVCCI with wedge (left) and IVCCI without wedge (right) for predicting post- spinal hypotension
Figure 4
Figure 4
Receiver operating characteristics curve of IVCdmax with wedge (left) and IVCdmax without wedge (right) for predicting post- spinal hypotension

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