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Varvarousi G, Barba C, Protopapas A, Pavlidis M, Valsamidis D. Agenesis of inferior vena cava in pregnancy: A case report and narrative review. Eur J Obstet Gynecol Reprod Biol 2024; 299:22-25. [PMID: 38823309 DOI: 10.1016/j.ejogrb.2024.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/20/2024] [Accepted: 05/25/2024] [Indexed: 06/03/2024]
Abstract
Agenesis of inferior vena cava (AIVC) is an extremely rare congenital abnormality. In AIVC, venous flow from the lower extremities enter superior vena cava mainly through the azygous and hemiazygous system, forming anastomotic collateral vessels. A global increase in intra-abdominal pressure by the gravid uterus may further stress the collateral system, increase venous stasis and decrease venous return. We present the management of a 37-year old pregnant woman with AIVC who underwent caesarean section with norepinephrine infusion and general anaesthesia. She presented with shortness of breath when seated, episodes of dizziness while walking or sitting upright with subsequent tachycardia. Cardiac status was monitored using an arterial pulse contour CO monitor. We did not observe large fluctuations in CO, SV, MAP during induction and intubation as well as during delivery. We believe that administration of an infusion of norepinephrine from induction to anaesthesia through caesarean section contributed to this result. Sympathetic activation caused venoconstriction, which significantly increased venous return and maintained haemodynamic stability.
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Affiliation(s)
- G Varvarousi
- Department of Anaesthesiology, ''Alexandra" General Hospital, Athens, Greece.
| | - C Barba
- Department of Anaesthesiology, ''Alexandra" General Hospital, Athens, Greece
| | - A Protopapas
- Department of Obstetrics & Gynecology, ''Alexandra" General Hospital, University of Athens, Athens, Greece
| | - M Pavlidis
- Department of Anaesthesiology, ''Alexandra" General Hospital, Athens, Greece
| | - D Valsamidis
- Department of Anaesthesiology, ''Alexandra" General Hospital, Athens, Greece
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2
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Kember AJ, Anderson JL, Gorazd NE, House SC, Kerr KE, Torres Loza PA, Reuter DG, Hobson SR, Goergen CJ. Maternal posture-physiology interactions in human pregnancy: a narrative review. Front Physiol 2024; 15:1370079. [PMID: 39100275 PMCID: PMC11294255 DOI: 10.3389/fphys.2024.1370079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 07/02/2024] [Indexed: 08/06/2024] Open
Abstract
There are several well-known medical conditions in which posture and gravity interact with natural history, including pregnancy. In this review, we provide a comprehensive overview of interactions between maternal posture and maternal physiology and pathophysiology at rest during pregnancy. We conducted a systematic literature search of the MEDLINE database and identified 644 studies from 1991 through 2021, inclusive, that met our inclusion criteria. We present a narrative review of the resulting literature and highlight discrepancies, research gaps, and potential clinical implications. We organize the results by organ system and, commencing with the neurological system, proceed in our synthesis generally in the craniocaudal direction, concluding with the skin. The circulatory system warranted our greatest and closest consideration-literature concerning the dynamic interplay between physiology (heart rate, stroke volume, cardiac output, blood pressure, and systemic vascular resistance), pathophysiology (e.g., hypertension in pregnancy), and postural changes provide an intricate and fascinating example of the importance of the subject of this review. Other organ systems discussed include respiratory, renal, genitourinary, gastrointestinal, abdominal, and endocrine. In addition to summarizing the existing literature on maternal posture-physiology interactions, we also point out gaps and opportunities for further research and clinical developments in this area. Overall, our review provides both insight into and relevance of maternal posture-physiology interactions vis à vis healthcare's mission to improve health and wellness during pregnancy and beyond.
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Affiliation(s)
- Allan J. Kember
- Temerty Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
- Shiphrah Biomedical Inc., Toronto, ON, Canada
| | - Jennifer L. Anderson
- Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Natalyn E. Gorazd
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Sarah C. House
- Temerty Faculty of Medicine, Medical Education, University of Toronto, Toronto, ON, Canada
| | - Katherine E. Kerr
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Paula A. Torres Loza
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - David G. Reuter
- Cardiac Innovations, Seattle Children’s, Seattle, WA, United States
| | - Sebastian R. Hobson
- Temerty Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Maternal-Fetal Medicine Division, Mount Sinai Hospital, Toronto, ON, Canada
| | - Craig J. Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
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3
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The venous system during pregnancy. Part 1: physiologic considerations on the venous system. Int J Obstet Anesth 2022; 50:103273. [DOI: 10.1016/j.ijoa.2022.103273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/13/2022] [Accepted: 02/17/2022] [Indexed: 12/20/2022]
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4
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Wilson DL, Fung AM, Skrzypek H, Pell G, Barnes M, Howard ME, Walker SP. Maternal sleep behaviours preceding fetal heart rate events on cardiotocography. J Physiol 2022; 600:1791-1806. [DOI: 10.1113/jp282528] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/17/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Danielle L. Wilson
- Institute for Breathing and Sleep, Austin Health Heidelberg Victoria Australia
- Department of Obstetrics and Gynaecology University of Melbourne Parkville Victoria Australia
| | - Alison M. Fung
- Mercy Perinatal Mercy Hospital for Women Heidelberg Victoria Australia
| | - Hannah Skrzypek
- Department of Obstetrics and Gynaecology University of Melbourne Parkville Victoria Australia
- Mercy Perinatal Mercy Hospital for Women Heidelberg Victoria Australia
| | - Gabrielle Pell
- Department of Obstetrics and Gynaecology University of Melbourne Parkville Victoria Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Health Heidelberg Victoria Australia
- Department of Medicine University of Melbourne Parkville Victoria Australia
| | - Mark E. Howard
- Institute for Breathing and Sleep, Austin Health Heidelberg Victoria Australia
- Department of Medicine University of Melbourne Parkville Victoria Australia
| | - Susan P. Walker
- Department of Obstetrics and Gynaecology University of Melbourne Parkville Victoria Australia
- Mercy Perinatal Mercy Hospital for Women Heidelberg Victoria Australia
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Dell'Agnolo CM, Delatore S, de Carvalho ECA, Pelloso SM, Cardelli AAM. Prepartum, childbirth, and immediate puerperium: Nursing diagnoses of mothers of extremely preterm infants. Int J Nurs Knowl 2021; 33:207-214. [PMID: 34613644 DOI: 10.1111/2047-3095.12349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/17/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Maternal mortality remains high, despite all the advances and efforts that have occurred in recent years and is directly related to the quality of care provided during pregnancy, childbirth, and in the puerperium. PURPOSE Identify the possible nursing diagnoses of mothers of newborns admitted to neonatal intensive care in the prepartum period, childbirth, and the puerperium. METHODS Observational, cross-sectional study carried out by analyzing the medical records of mothers of newborns who required hospitalization in neonatal intensive care and determining the diagnoses through a process of diagnostic inference, based on NANDA-I Taxonomy, during the period from 2007 to 2016. FINDINGS After reviewing the medical records of 272 mothers, a total of 3,843 observations were identified, distributed in 42 diagnoses, with Excessive fluid volume presenting the greatest predictive power over the outcome variable. The second group of more predictive variables comprised the Risk of vascular trauma, Risk of infection, Impaired parenthood, and Risk of body temperature imbalance. The third group, in turn, consisted of the following diagnoses: Insomnia, Pain during labor, Risk of impaired bonding, Acute pain, and Ineffective Breastfeeding. CONCLUSIONS The present study enabled the identification of the most frequent NANDA-I nursing diagnoses occurring during the prepartum period, childbirth, and the immediate puerperium of mothers of newborns admitted to neonatal intensive care, as well as those of greatest importance. Based on the encountered diagnoses, it can be concluded that future studies should be carried out in order for validation. IMPLICATIONS The knowledge of these diagnoses can contribute to the instrumentalization of nursing professionals, with consequent improvements in the nursing process and the provided assistance, aiming to assist in the reduction of maternal morbidity and mortality.
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Affiliation(s)
- Cátia M Dell'Agnolo
- Assistant Professor, Post Graduate Program in Health Sciences, Professional Masters in Management, Technology and Innovation in Urgency and Emergency, Medicine Department, Maringá State University, Maringá, Paraná, Brazil
| | - Silvana Delatore
- Assistant Nursing, Hospital University of Maringá, Maringá, Paraná, Brazil
| | - Elias C A de Carvalho
- Assistant Professor, Post Graduate Program in Health Sciences, Professional Masters in Management, Technology and Innovation in Urgency and Emergency, Medicine Department, Maringá State University, Maringá, Paraná, Brazil
| | - Sandra Marisa Pelloso
- Professor, Post Graduate Program in Health Sciences, Maringá State University, Maringá, Paraná, Brazil
| | - Alexandrina A M Cardelli
- Professor, Department of Health Sciences, State University of Londrina, Londrina, Paraná, Brazil
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Supine hypotensive syndrome of pregnancy: A review of current knowledge. Eur J Anaesthesiol 2021; 39:236-243. [PMID: 34231500 DOI: 10.1097/eja.0000000000001554] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since the first description of supine hypotensive syndrome in the 1950s, its potentially detrimental effects on otherwise healthy women during late pregnancy have become a persistent challenge in obstetric practice. Establishing a 15° left lateral tilt during labour and caesarean section is a fundamental principle of obstetric care, universally adopted and upheld by current guidelines and recommendations. Reassessment of the original landmark studies in the light of current physiological and anatomical knowledge questions adherence to this standard in clinical practice. The modern practice of providing vasopressor support during caesarean delivery under neuraxial anaesthesia appears to negate any potential negative effects of a maternal full supine position. Recent MRI studies provide evidence as to the cause of supine hypotension and the physiological effects of different maternal positions at term. This review highlights current data on the acute supine hypotensive syndrome in contrast to traditional knowledge and established practice.
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Lachkar S, Iwanaga J, Newton E, Dumont AS, Tubbs RS. Split Azygos Vein: A Case Report. Cureus 2021; 13:e13362. [PMID: 33747658 PMCID: PMC7970156 DOI: 10.7759/cureus.13362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The azygos venous system, which comprises the azygos, hemiazygos, and accessory hemiazygos veins, assists in blood drainage into the superior vena cava (SVC) from the thoracic cage and portions of the posterior mediastinum. Routine dissection of a fresh-frozen cadaveric specimen revealed a split azygos vein. The azygos vein branched off the inferior vena cava (IVC) at the level of the second lumbar vertebra as a single trunk and then split into two tributaries after forming a venous plexus. The right side of this system drained into the SVC and, inferiorly, the collective system drained into the IVC. Variant forms in the venous system, especially the vena cavae, are prone to dilation and tortuosity, leading to an increased likelihood of injury. Knowledge of the anatomical variations of the azygos vein is important for surgeons who use an anterior approach to the spine for diverse procedures.
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Affiliation(s)
| | - Joe Iwanaga
- Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Emma Newton
- Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Aaron S Dumont
- Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - R Shane Tubbs
- Neurosurgery, Tulane University School of Medicine, New Orleans, USA
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Avila WS, Alexandre ERG, Castro MLD, Lucena AJGD, Marques-Santos C, Freire CMV, Rossi EG, Campanharo FF, Rivera IR, Costa MENC, Rivera MAM, Carvalho RCMD, Abzaid A, Moron AF, Ramos AIDO, Albuquerque CJDM, Feio CMA, Born D, Silva FBD, Nani FS, Tarasoutchi F, Costa Junior JDR, Melo Filho JXD, Katz L, Almeida MCC, Grinberg M, Amorim MMRD, Melo NRD, Medeiros OOD, Pomerantzeff PMA, Braga SLN, Cristino SC, Martinez TLDR, Leal TDCAT. Brazilian Cardiology Society Statement for Management of Pregnancy and Family Planning in Women with Heart Disease - 2020. Arq Bras Cardiol 2020; 114:849-942. [PMID: 32491078 PMCID: PMC8386991 DOI: 10.36660/abc.20200406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Walkiria Samuel Avila
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Marildes Luiza de Castro
- Hospital das Clínicas da Faculdade de Medicina da Universidade Federal de Minas gerais (UFMG),Belo Horizonte, MG - Brasil
| | | | - Celi Marques-Santos
- Universidade Tiradentes,Aracaju, SE - Brasil.,Hospital São Lucas, Rede D'Or Aracaju,Aracaju, SE - Brasil
| | | | - Eduardo Giusti Rossi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Felipe Favorette Campanharo
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil.,Hospital Israelita Albert Einstein,São Paulo, SP - Brasil
| | | | - Maria Elizabeth Navegantes Caetano Costa
- Cardio Diagnóstico,Belém, PA - Brasil.,Centro Universitário Metropolitano da Amazônia (UNIFAMAZ),Belém, PA - Brasil.,Centro Universitário do Estado Pará (CESUPA),Belém, PA - Brasil
| | | | | | - Alexandre Abzaid
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Antonio Fernandes Moron
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Carlos Japhet da Mata Albuquerque
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil,Hospital Barão de Lucena, Recife, PE – Brazil,Hospital EMCOR, Recife, PE – Brazil,Diagnósticos do Coração LTDA, Recife, PE – Brazil
| | | | - Daniel Born
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Fernando Souza Nani
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Flavio Tarasoutchi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - José de Ribamar Costa Junior
- Hospital do Coração (HCor),São Paulo, SP - Brasil.,Instituto Dante Pazzanese de Cardiologia,São Paulo, SP - Brasil
| | | | - Leila Katz
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil
| | | | - Max Grinberg
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Nilson Roberto de Melo
- Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP – Brazil
| | | | - Pablo Maria Alberto Pomerantzeff
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
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9
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Faulkes RE, Chauhan A, Knox E, Johnston T, Thompson F, Ferguson J. Review article: chronic liver disease and pregnancy. Aliment Pharmacol Ther 2020; 52:420-429. [PMID: 32598048 DOI: 10.1111/apt.15908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/02/2020] [Accepted: 06/01/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The prevalence of chronic liver disease in women of child bearing age is increasing, leading to a higher incidence of pregnancy in this cohort. Chronic medical conditions have a significant adverse effect on maternal morbidity and mortality. To date, reviews on this topic have been written either from a hepatology or obstetrics viewpoint, and no specific guidelines are available solely for the management of chronic liver disease in pregnancy. AIMS To produce a comprehensive review on the clinical management of women with chronic liver disease during pregnancy, addressing the risks of pregnancy to mother and child, how these risks can be ameliorated, and what additional considerations are required for management of chronic liver disease in pregnancy. METHODS Data were collected up to May 2020 from the biomedical database PubMed, national and international guidelines in gastroenterology and hepatology. RESULTS During pregnancy, women with cirrhosis are more likely to develop decompensated disease, worsening of portal hypertension, and to deliver premature infants. CONCLUSIONS The risks associated with pregnancy can be ameliorated by advanced planning, assessing risk using the model for end stage liver disease score and risk reduction through varices screening. A multidisciplinary approach is paramount in order to minimise complications and maximise the chance of a safe pregnancy and birth for mother and baby.
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Affiliation(s)
| | - Abhishek Chauhan
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.,Centre for Liver Research, Institute of Immunology and Inflammation, and National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, The Medical School, University of Birmingham, Birmingham, UK
| | - Ellen Knox
- Birmingham Womens' Hospital, Birmingham, UK
| | | | | | - James Ferguson
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.,Centre for Liver Research, Institute of Immunology and Inflammation, and National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, The Medical School, University of Birmingham, Birmingham, UK
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10
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Ishkova A, Wilson DL, Howard ME, Walker SP, Barnes M, Nicholas CL, Jordan AS. The effect of body position on maternal cardiovascular function during sleep and wakefulness in late pregnancy. J Matern Fetal Neonatal Med 2020; 35:2545-2554. [PMID: 32669005 DOI: 10.1080/14767058.2020.1789583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION An association between the increased risk of late stillbirth and the maternal supine sleeping position has been recently established. The risk of stillbirth following supine sleep has been suspected to occur as a result of aortocaval compression by the gravid uterus. A number of studies conducted during wakefulness have reported compromised cardiovascular function during supine rest, as demonstrated by reductions in cardiac output, blood pressure and utero-placental blood flow. It remains unclear whether similar effects are also present during sleep, due to the presence of key sleep-specific changes in cardiovascular function. OBJECTIVE To investigate the changes in maternal cardiovascular function between the supine and left-lateral positions during wakefulness and non-rapid eye movement (NREM) sleep in late pregnancy. METHODS Twenty-nine women with a singleton pregnancy between 24.7 and 36.7 weeks' gestation participated in a single overnight sleep study. Physiological measures (blood pressure, heart rate, heart rate variability - HRV, and pulse arrival time - PAT) were measured and recorded throughout the night using standard polysomnography equipment and the Portapres Model-2 device. As the present study evaluated cardiovascular changes during natural rest and sleep in pregnancy, participants were not given explicit instructions on which position to adopt. Body position was continuously recorded using a position monitor and verified with video recording. RESULTS No changes in systolic, diastolic or mean arterial blood pressure were observed between the left-lateral and supine positions during wakefulness or sleep. However, heart rate was significantly higher in the supine position compared to the left during wakefulness (p= .03), with a similar trend present during sleep (p= .11). A significantly shorter PAT was measured in the supine position (compared to the left) during wakefulness (p= .01) and sleep (p= .01). No change in HRV measures was observed between the left and supine positions in either state. CONCLUSION Blood pressure did not appear to differ significantly between the left-lateral and supine positions during wakefulness and sleep. The lack of blood pressure differences may reflect elevated sympathetic activity during rest and sleep in the supine position (compared to the left), suggesting that some degree of compensation for aortocaval compression may still be possible during sleep.
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Affiliation(s)
- Anna Ishkova
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia
| | - Danielle L Wilson
- Austin Health, Institute for Breathing and Sleep, Heidelberg, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Australia.,Department of Medicine, University of Melbourne, Parkville, Australia
| | - Mark E Howard
- Austin Health, Institute for Breathing and Sleep, Heidelberg, Australia.,Department of Medicine, University of Melbourne, Parkville, Australia
| | - Susan P Walker
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
| | - Maree Barnes
- Austin Health, Institute for Breathing and Sleep, Heidelberg, Australia
| | - Christian L Nicholas
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia.,Austin Health, Institute for Breathing and Sleep, Heidelberg, Australia
| | - Amy S Jordan
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia.,Austin Health, Institute for Breathing and Sleep, Heidelberg, Australia
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11
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Humphries A, Thompson JMD, Stone P, Mirjalili SA. The effect of positioning on maternal anatomy and hemodynamics during late pregnancy. Clin Anat 2020; 33:943-949. [PMID: 32329156 DOI: 10.1002/ca.23614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Supine positioning during late pregnancy causes dramatic compression of maternal abdominal vasculature and is a risk factor for stillbirth. The azygos vein has been shown to provide collateral circulation in this scenario. There are many well-known anatomical differences in abdominal vasculature between the left and right sides of the body. However, the effect of left and right positioning in pregnancy has not been well studied. MATERIALS AND METHODS After obtaining ethics approval, 10 women with uncomplicated pregnancies between 34 and 38 weeks gestation underwent magnetic resonance imaging in the left and right lateral positions. Phase contrast images were evaluated to measure blood flow through the abdominal aorta, inferior vena cava, and azygos vein. RESULTS No significant differences between left and right lateral positions were found in blood flow through the IVC at its formation (mean difference -0.15 L/min [CI -0.47, 0.18], p = .34) or through the azygos vein (mean difference 0.02 L/min [CI -0.22, 0.26], p = .87). Blood flow through the IVC just above the level of the renal veins was found to be reduced by 35% in the right lateral position when compared to the left (mean difference 1.01 L/min [CI 0.25, 1.43], p = .03). There were no significant differences in cardiac output or blood flow through the abdominal aorta. CONCLUSIONS While it was noted that blood flow through the IVC immediately above the level of the renal veins was reduced in the right lateral position, this did not appear to impact significantly on maternal cardiac output or blood flow through the azygos vein.
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Affiliation(s)
- Aimee Humphries
- Department of Anatomy and Medical Imaging, The University of Auckland, Auckland, New Zealand.,Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - John M D Thompson
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Peter Stone
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - Seyed Ali Mirjalili
- Department of Anatomy and Medical Imaging, The University of Auckland, Auckland, New Zealand
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12
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Venous Drainage of Lumbar Vertebral Bodies: Anatomic Study with Application to Kyphoplasty, Vertebroplasty, and Pedicle Screw Complications. World Neurosurg 2020; 137:e286-e290. [PMID: 32014549 DOI: 10.1016/j.wneu.2020.01.174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Bone cement augmentation with polymethylmethacrylate is a reliable method for stabilizing osteoporotic compression fractures and improving fixation of pedicle screws. However, cement extrusion into the vertebral venous system can result in pulmonary cement embolism. The goal of this anatomic study was to identify the relationship between the internal/external vertebral plexus and neighboring abdominal caval system. METHODS Thirty-two lumbar vertebral levels were used in this study. Anterior abdominal dissection was performed to access the lumbar vertebral bodies through the peritoneal cavity, and a 16-gauge needle was placed into the center of each lumbar vertebral body at its anterior aspect. Fluoroscopy was used to confirm if the needle was correctly placed. Next, latex and/or continuous air injections were performed into each lumbar vertebral level (L1-L5). Observations confirmed if the latex or air traveled into the inferior vena cava. In addition, the spinal canal was opened to see if any latex was found to enter inside the vertebral canal in cadavers injected with the latex. RESULTS Latex or air was found to flow into the inferior vena cava at all the lumbar vertebral levels. The latex/air was not observed in the spinal canal in any specimen. CONCLUSIONS An exact knowledge of the lumbar vertebral venous anatomy is essential when procedures that could affect the vertebral venous system are involved. Its complexity and anatomic variability necessitate such an understanding to better prevent/understand possible complications associated with polymethylmethacrylate extrusion.
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13
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Humphries A, Mirjalili SA, Tarr GP, Thompson JMD, Stone P. Hemodynamic changes in women with symptoms of supine hypotensive syndrome. Acta Obstet Gynecol Scand 2019; 99:631-636. [PMID: 31856296 DOI: 10.1111/aogs.13789] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/11/2019] [Accepted: 12/14/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Supine positioning during late pregnancy causes the gravid uterus to compress the inferior vena cava, resulting in dramatic hemodynamic changes. The maintenance of placental perfusion requires maternal circulatory and autonomic adaptations. Women with supine hypotensive syndrome (defined as a drop in systolic blood pressure of anything between 15 and 30 mmHg or an increase in heart rate of 20 bpm, with or without symptoms) may have reduced ability to compensate for the effects of supine positioning. MATERIAL AND METHODS Twelve women with uncomplicated pregnancies and no symptoms of supine hypotension (normal) and 10 women with uncomplicated pregnancies who reported symptoms of supine hypotension between 34 and 38 weeks' gestation underwent magnetic resonance imaging in the supine and left lateral positions. Phase contrast images were evaluated to measure blood flow through the aorta, inferior vena cava, superior vena cava and azygos vein. RESULTS Women with symptoms of supine hypotension showed significant reductions in azygos venous flow rate compared with the normal group (-0.15 (-0.30 to -0.01) L/min). Those with symptoms showed no statistically significant compensatory changes in heart rate compared with the normal group (heart rate change 4.5 (-3.1 to 12.1) bpm). Hemodynamic changes in response to positioning were similar across both groups including: a reduction in inferior vena cava blood flow, reduction in cardiac output and an increase in azygos blood flow. CONCLUSIONS Maternal hemodynamic adaptations were found to be consistent across groups irrespective of whether the women had symptoms of supine hypotension. In both groups a reduction in blood flow through the inferior vena cava occurred in the supine position with a subsequent reduction in cardiac output. Both groups showed a compensatory increase in blood flow through the azygos vein in order to partially compensate for this. Taking into account the effect of maternal position, women with symptoms were found to have reduced azygos flow compared with asymptomatic women. There was a significant increase in heart rate when the women were supine than when they were in the left lateral position.
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Affiliation(s)
- Aimee Humphries
- Department of Anatomy and Medical Imaging, The University of Auckland, Auckland, New Zealand.,Department of Obstetrics and Gynecology, The University of Auckland, Auckland, New Zealand
| | - Seyed A Mirjalili
- Department of Anatomy and Medical Imaging, The University of Auckland, Auckland, New Zealand
| | - Gregory P Tarr
- Department of Radiology, Middlemore Hospital, Auckland, New Zealand
| | - John M D Thompson
- Department of Obstetrics and Gynecology, The University of Auckland, Auckland, New Zealand.,Department of Pediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Peter Stone
- Department of Obstetrics and Gynecology, The University of Auckland, Auckland, New Zealand
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Coleman J, Okere M, Seffah J, Kember A, O'Brien LM, Borazjani A, Butler M, Wells J, MacRitchie S, Isaac A, Chu K, Scott H. The Ghana PrenaBelt trial: a double-blind, sham-controlled, randomised clinical trial to evaluate the effect of maternal positional therapy during third-trimester sleep on birth weight. BMJ Open 2019; 9:e022981. [PMID: 31048420 PMCID: PMC6502032 DOI: 10.1136/bmjopen-2018-022981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the effect, on birth weight and birth weight centile, of use of the PrenaBelt, a maternal positional therapy device, during sleep in the home setting throughout the third trimester of pregnancy. DESIGN A double-blind, sham-controlled, randomised clinical trial. SETTING Conducted from September 2015 to May 2016, at a single, tertiary-level centre in Accra, Ghana. PARTICIPANTS Two-hundred participants entered the study. One-hundred-eighty-one participants completed the study. Participants were women, 18 to 35 years of age, with low-risk, singleton, pregnancies in their third-trimester, with body mass index <35 kg/m2 at the first antenatal appointment for the index pregnancy and without known foetal abnormalities, pregnancy complications or medical conditions complicating sleep. INTERVENTIONS Participants were randomised by computer-generated, one-to-one, simple randomisation to receive either the PrenaBelt or sham-PrenaBelt. Participants were instructed to wear their assigned device to sleep every night for the remainder of their pregnancy (approximately 12 weeks in total) and were provided a sleep diary to track their use. Allocation concealment was by unmarked, security-tinted, sealed envelopes. Participants and the outcomes assessor were blinded to allocation. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were birth weight and birth weight centile. Secondary outcomes included adherence to using the assigned device nightly, sleeping position, pregnancy outcomes and feedback from participants and maternity personnel. RESULTS One-hundred-sixty-seven participants were included in the primary analysis. The adherence to using the assigned device nightly was 56%. The mean ±SD birth weight in the PrenaBelt group (n=83) was 3191g±483 and in the sham-PrenaBelt group (n=84) was 3081g±484 (difference 110 g, 95% CI -38 to 258, p=0.14). The median (IQR) customised birth weight centile in the PrenaBelt group was 43% (18 to 67) and in the sham-PrenaBelt group was 31% (14 to 58) (difference 7%, 95% CI -2 to 17, p=0.11). CONCLUSIONS The PrenaBelt did not have a statistically significant effect on birth weight or birth weight centile in comparison to the sham-PrenaBelt. TRIAL REGISTRATION NUMBER NCT02379728.
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Affiliation(s)
- Jerry Coleman
- Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
- University of Ghana School of Medicine and Dentistry, Accra, Greater Accra, Ghana
| | - Maxfield Okere
- Biostatistics, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - Joseph Seffah
- Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
- University of Ghana School of Medicine and Dentistry, Accra, Greater Accra, Ghana
| | - Allan Kember
- Obstetrics & Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Louise M O'Brien
- University of Michigan Department of Obstetrics and Gynaecology, Ann Arbor, Michigan, USA
| | - Ali Borazjani
- Global Innovations for Reproductive Health & Life, Cleveland, Ohio, USA
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Michael Butler
- Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Jesse Wells
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Andre Isaac
- Innovative Canadians for Change, Edmonton, Alberta, Canada
| | - Kaishin Chu
- Method Squared Designhaus, Surrey, British Columbia, Canada
| | - Heather Scott
- Obstetrics & Gynaecology, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
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15
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Mehta K, Iwanaga J, Tubbs RS. Absence of the Right Common Iliac Vein with the Right Internal Iliac Vein Arising from the Left Common Iliac Vein: Case Report. Cureus 2019; 11:e4575. [PMID: 31281758 PMCID: PMC6605961 DOI: 10.7759/cureus.4575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The common iliac vein arises from the internal and external iliac veins and drains into the inferior vena cava, bilaterally. Historically, many anatomical variants of the common iliac vein have been studied. To our knowledge, we discuss a unique specimen, which presents with an absent right common iliac vein and a right internal iliac vein draining into the contralateral common iliac vein. It is important that we understand the anatomic variations of the pelvic venous system to prevent iatrogenic injury to patients or misdiagnosis.
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Affiliation(s)
- Karishma Mehta
- Clinical Anatomy, Seattle Science Foundation, Seattle, USA
| | - Joe Iwanaga
- Medical Education and Simulation, Seattle Science Foundation, Seattle, USA
| | - R Shane Tubbs
- Neurosurgery, Seattle Science Foundation, Seattle, USA
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Kember AJ, Scott HM, O'Brien LM, Borazjani A, Butler MB, Wells JH, Isaac A, Chu K, Coleman J, Morrison DL. Modifying maternal sleep position in the third trimester of pregnancy with positional therapy: a randomised pilot trial. BMJ Open 2018; 8:e020256. [PMID: 30158217 PMCID: PMC6119420 DOI: 10.1136/bmjopen-2017-020256] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate whether the percentage of time spent supine during sleep in the third trimester of pregnancy could be reduced using a positional therapy device (PrenaBelt) compared with a sham device. DESIGN A double-blind, randomised, sham-controlled, cross-over pilot trial. SETTING Conducted between March 2016 and January 2017, at a single, tertiary-level centre in Canada. PARTICIPANTS 23 participants entered the study. 20 participants completed the study. Participants were low-risk, singleton, third-trimester pregnant women aged 18 years and older with body mass index <35 kg/m2 at the first antenatal appointment for the index pregnancy and without known fetal abnormalities, pregnancy complications or medical conditions complicating sleep. INTERVENTIONS A two-night, polysomnography study in a sleep laboratory. Participants were randomised by computer-generated, one-to-one, simple randomisation to receive either a PrenaBelt or a sham-PrenaBelt on the first night and were crossed over to the alternate device on the second night. Allocation concealment was by unmarked, security-tinted, sealed envelopes. Participants, the recruiter and personnel involved in setting up, conducting, scoring and interpreting the polysomnogram were blinded to allocation. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the percentage of time spent supine during sleep. Secondary outcomes included maternal sleep architecture, respiration, self-reported sleep position and feedback. RESULTS The median percentage of sleep time supine was reduced from 16.4% on the sham night to 3.5% on the PrenaBelt night (pseudomedian=5.8, p=0.03). We were unable to demonstrate differences in sleep architecture or respiration. Participants underestimated the time they spent sleeping supine by 7.0%, and six (30%) participants indicated they would make changes to the PrenaBelt. There were no harms in this study. CONCLUSIONS This study demonstrates that the percentage of sleep time supine during late pregnancy can be significantly reduced via positional therapy. TRIAL REGISTRATION NUMBER NCT02377817; Results.
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Affiliation(s)
- Allan J Kember
- Dalhousie Medical School, Halifax, Nova Scotia, Canada
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Global Innovations for Reproductive Health & Life, Cleveland, Ohio, USA
| | - Heather M Scott
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Louise M O'Brien
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ali Borazjani
- Global Innovations for Reproductive Health & Life, Cleveland, Ohio, USA
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | | | | | - Andre Isaac
- Innovative Canadians for Change, Edmonton, Alberta, Canada
| | - Kaishin Chu
- Method Squared Designhaus, Surrey, British Columbia, Canada
| | - Jerry Coleman
- Obstetrics and Gynaecology Department, Korle Bu Teaching Hospital, Accra, Ghana
- School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Debra L Morrison
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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17
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Humphries A, Mirjalili SA, Tarr GP, Thompson JMD, Stone P. The effect of supine positioning on maternal hemodynamics during late pregnancy. J Matern Fetal Neonatal Med 2018; 32:3923-3930. [DOI: 10.1080/14767058.2018.1478958] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Aimee Humphries
- Department of Anatomy and Medical Imaging, The University of Auckland, Auckland, New Zealand
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - S. Ali Mirjalili
- Department of Anatomy and Medical Imaging, The University of Auckland, Auckland, New Zealand
| | - Gregory P. Tarr
- Department of Radiology, Auckland Hospital, Auckland, New Zealand
| | - John M. D. Thompson
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
- Department of Paediatrics, The University of Auckland, Auckland, New Zealand
| | - Peter Stone
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
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