Stroke Volume Recruitability during the Third Trimester of Pregnancy
23 August 2017
16 November 2017
26 December 2017 (eFirst)
Objective It is unknown whether the heart operates in the ascending or flat portion of the Starling curve during normal pregnancy. Pregnant women do not respond to the passive leg-raising maneuver secondary to mechanical obstruction of the inferior vena cava by the gravid uterus. Our objective was to evaluate if administration of a fluid bolus increases baseline stroke volume (SV) among healthy pregnant patients during the third trimester.
Study Design Healthy pregnant women who underwent elective term cesarean sections were included. A noninvasive cardiac output monitor was used to measure hemodynamic variables at baseline and after administration of a 500-mL crystalloid bolus.
Results Forty-five women were included in the study. Fluid administration was associated with a statistically significant increase in SV from a baseline value of 71 ± 11 to 90 ± 19 mL (95% confidence interval [CI]: 13.67–21.49; p < 0.01) and a significant decrease in maternal heart rate from a baseline of 87 ± 9 beats per minute to 83 ± 8 after the fluid bolus (95% CI: −6.81 to −2.78; p = 0.03). No changes in peripheral vascular resistances or any other measured hemodynamic parameters were noted with volume expansion.
Conclusion In healthy term pregnancy, the heart operates in the ascending portion of the Starling's curve, rendering it fluid responsive.
- 1 Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med 2009; 37 (09) 2642-2647
- 2 Boulain T, Achard JM, Teboul JL, Richard C, Perrotin D, Ginies G. Changes in BP induced by passive leg raising predict response to fluid loading in critically ill patients. Chest 2002; 121 (04) 1245-1252
- 3 Audimoolam VK, McPhail MJ, Willars C. , et al. Predicting fluid responsiveness in acute liver failure: a prospective study. Anesth Analg 2017; 124 (02) 480-486
- 4 Marques NR, Martinello C, Kramer GC. , et al. Passive leg raising during pregnancy. Am J Perinatol 2015; 32 (04) 393-398
- 5 Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest 2008; 134 (01) 172-178
- 6 Osman D, Ridel C, Ray P. , et al. Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med 2007; 35 (01) 64-68
- 7 Cheung H, Dong Q, Dong R, Yu B. Correlation of cardiac output measured by non-invasive continuous cardiac output monitoring (NICOM) and thermodilution in patients undergoing off-pump coronary artery bypass surgery. J Anesth 2015; 29 (03) 416-420
- 8 Vinayagam D, Patey O, Thilaganthan B, Khalil A. A cross comparison study of NICOM and transthoracic echocardiography in pregnancy. J Matern Fetal Neonatal Med 2016; 29 (02) 40
- 9 Waldron NH, Miller TE, Thacker JK. , et al. A prospective comparison of a noninvasive cardiac output monitor versus esophageal Doppler monitor for goal-directed fluid therapy in colorectal surgery patients. Anesth Analg 2014; 118 (05) 966-975
- 10 Berkenstadt H, Margalit N, Hadani M. , et al. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery. Anesth Analg 2001; 92 (04) 984-989
- 11 Guinot PG, Urbina B, de Broca B, Bernard E, Dupont H, Lorne E. Predictability of the respiratory variation of stroke volume varies according to the definition of fluid responsiveness. Br J Anaesth 2014; 112 (03) 580-581
- 12 Monge García MI, Guijo González P, Gracia Romero M. , et al. Effects of fluid administration on arterial load in septic shock patients. Intensive Care Med 2015; 41 (07) 1247-1255