Cardiac Output Changes With Uterine Displacement

Study Overview
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Brief Summary
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There is currently little information regarding the hemodynamic differences in uterine displacement techniques. Previous studies examining the hemodynamic effects of uterine displacement maneuvers have focused on incidence of hypotension and use of ephedrine. Noninvasive cardiac output monitoring (NICOM) and transthoracic echocardiography (TTE) are becoming popular techniques in anesthesiology because they can provide noninvasive, valid, and precise hemodynamic data.There has been no study specifically examining the hemodynamic differences between the uterine displacement techniques using NICOM or TTE. While all three uterine displacement techniques are recommended, whether one technique may maximize maternal cardiac output is currently unknown.

Detailed Description
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Aortocaval compression is a well-recognized physiologic concern in pregnancy. The gravid uterus can compress the inferior vena cava, impeding venous return and thereby reducing stroke volume and cardiac output. The 2014 Society for Obstetric Anesthesia and Perinatology consensus statement on the management of cardiac arrest in pregnancy, and the 2010 American Heart Association guideline on maternal cardiac arrest recommend relieving aortocaval compression during chest compressions by performing uterine displacement There is currently little information regarding the hemodynamic differences amongst the recommended uterine displacement techniques. Previous studies examining the hemodynamic effects of uterine displacement maneuvers have focused on incidence of hypotension and use of ephedrine. Noninvasive cardiac output monitoring (NICOM) and transthoracic echocardiography (TTE) are becoming popular techniques in anesthesiology because they can provide noninvasive, valid, and precise hemodynamic data.There has been no study specifically examining the hemodynamic differences between the uterine displacement techniques using NICOM or TTE. While all three uterine displacement techniques are recommended, whether one technique may maximize maternal cardiac output is currently unknown.

Official Title
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Assessement of Hemodynamic Changes Associated With Uterine Displacement Using Noninvasive Cardiac Output Monitoring and Transthoracic Echocardiography:

Conditions
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Obstetric Anesthesia, Cardiac Monitoring

Intervention / Treatment
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* Device: TTE / NICOM


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Healthy ASA physical status I-II Term parturient Exclusion Criteria: Woman in labor Presence of maternal medical conditions affecting the cardiovascular system (including preeclampsia, gestational hypertension) Fetal anomaly or intrauterine growth restriction (< 25th percentile) Maternal renal or endocrine disease

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: One handed uterine displacement<br>Uterine displacement using one hand | Device: TTE / NICOM<br> <br> * Other names: Transthoracic Echocardiography / Noninvasive Cardiac Output Monitor;|
| Active Comparator: two handed uterine displacement<br>Uterine displacement using two hands | Device: TTE / NICOM<br> <br> * Other names: Transthoracic Echocardiography / Noninvasive Cardiac Output Monitor;|
| Active Comparator: 30 degrees uterine displacement<br>Uterine displacement using a 30 degrees wedge | Device: TTE / NICOM<br> <br> * Other names: Transthoracic Echocardiography / Noninvasive Cardiac Output Monitor;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cardiac Output |  | 10 minutes |