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Arruda Correia ML, Peixoto Filho FM, Gomes Júnior SC, de Jesus GR. Effects of osteopathic manipulative treatment on maternal-fetal hemodynamics in third trimester pregnant women: A prospective study. PLoS One 2024; 19:e0300514. [PMID: 38507460 PMCID: PMC10954147 DOI: 10.1371/journal.pone.0300514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/24/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE To evaluate the maternal-fetal hemodynamic effects after osteopathic manipulative treatment by measuring vital signs and Doppler velocimetry in third-trimester pregnant women. MATERIALS AND METHODS This is a prospective study with pregnant women undergoing outpatient follow-up and hospitalized in a ward at Instituto Fernandes Figueira/Fiocruz, between August 2021 to August 2022, during the SARS-CoV-2 pandemic. This study was registered in REBEC under Register Number RBR-9q7kvg and approved by the ethics committee under number 32216620.0.0000.5269. The study population was composed of 51 pregnant women between 28 and 40 weeks of gestation, over 18 years of age, allocated in a single group. Pregnancies with multiple fetuses, malformations, premature rupture of the membrane, and active labor were excluded. The procedures evaluated maternal-fetal hemodynamics using three consecutive measures of ultrasound examination with Doppler velocimetry, and three maternal vital signs measured by an electronic blood pressure monitor. RESULTS Most vital signs changed after osteopathic treatment. However, only the systolic blood pressure (109.92 ±14.42 to 110.71±12.8, p = 0.033), diastolic blood pressure (79.8±11.54 to 77.57±9.44, p = 0.018) and heart rate (87.59±11.93 to 81.12±10.26, p = 0.000) in the sitting position, systolic blood pressure (110.75±13.26 to 108.59±13.07; p = 0.034) in the supine, and heart rate (83.22±11.29 to 80.39±11.0; p = 0.013) in left lateral decubitus reached statistical significance. The oximetry measures (98.55±0.64 to 98.67±0.68; p = 0.098) stayed stable during all three positions. All artery values remained stable after treatment, and no statistically significant difference was recorded in the artery results. CONCLUSION Responses to osteopathic treatment in women in the third trimester of pregnancy did not affect uteroplacental and fetoplacental circulation. However, some maternal vital signs had statistically significant results, with a decrease in diastolic blood pressure and heart rate, and an increase in systolic blood pressure in the sitting position, a decrease of heart rate in the left lateral decubitus position, and systolic blood pressure in the supine position. All the results observed were maintained in the normal parameters. The study responses attest to the safety of using the osteopathic manipulative treatment for the fetus and for pregnant women with comorbidities.
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Jayasundara S, Goonewardene M, Dassanayake L. The association between maternal intra-abdominal pressure and hypertension in pregnancy. PLoS One 2023; 18:e0284230. [PMID: 37851647 PMCID: PMC10584176 DOI: 10.1371/journal.pone.0284230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Pregnancy leads to a state of chronically increased intra-abdominal pressure (IAP) caused by a growing fetus, fluid, and tissue. Increased intra-abdominal pressure is leading to state of Intra-Abdominal Hypertension (IAH) and Abdominal Compartment Syndrome. Clinical features and risk factors of preeclampsia is comparable to abdominal compartment syndrome. IAP may be associated with the hypertension in pregnancy (HIP). OBJECTIVES The study aimed to determine the antepartum and postpartum IAP levels in women undergoing caesarean delivery (CD) and association between hypertension in pregnancy, and antepartum and postpartum IAP levels in women undergoing CD. METHOD Seventy pregnant women (55 normotensive, 15 HIP) undergoing antepartum, non-emergency CD, had their intravesical pressure measured before and after the CD, the intravesical pressure measurements obtained with the patient in the supine position were considered to correspond to the IAP. Multivariable linear regression models were used to study associations between intraabdominal pressure and baseline characteristics in normotensive pregnancies and hypertensive pregnancies. RESULTS In normotensive pregnancies at mean gestation age of 38.2 weeks (95%CI 37.9 to 38.6), mean antepartum IAP was 12.7 mmHg(95%CI 11.6 to 13.8) and the mean postpartum IAP was 7.3 mmHg (95% CI 11.6 to 13.8). Multivariable linear regression models showed HIP group antepartum IAP positively associated with coefficient value of 1.617 (p = 0.268) comparing with normotensive pregnancy group. Postpartum IAP in HIP group positively associated with coefficient value of 2.519 (p = 0.018) comparing with normotensive pregnancy group. IAP difference is negatively associated with HIP (coefficient -1.013, p = 0.179). CONCLUSION In normotensive pregnancies at term, the IAP was in the IAH range of the non-pregnant population. Higher Antepartum IAP and Postpartum IAP are associated with HIP. Reduction of IAP from antepartum period to postpartum period was less with HIP.
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Affiliation(s)
| | - Malik Goonewardene
- Academic Obstetric Unit, Teaching Hospital, Galle, Sri Lanka
- Department of obstetrics and gynaecology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Lanka Dassanayake
- Academic Obstetric Unit, Teaching Hospital, Galle, Sri Lanka
- Department of obstetrics and gynaecology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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Arruda Correia ML, Peixoto Filho FM, Gomes Júnior SC, Peixoto MVM. Effects of intra-abdominal hypertension on maternal-fetal outcomes in term pregnant women: A systematic review. PLoS One 2023; 18:e0280869. [PMID: 37368887 DOI: 10.1371/journal.pone.0280869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/10/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE To carry out a systematic review to assess the effects of intra-abdominal hypertension on maternal-fetal outcomes. METHODS The search was carried out between 28th June to 4th July 2022 on the Biblioteca Virtual em Saúde, Pubmed, Embase, Web of Science, and Cochrane databases. The study was registered in PROSPERO (CRD42020206526). The systematic review was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. To assess the methodological quality and control the risk of bias, New Castle was used. RESULTS A total of 6203 articles were found. Of these, 5 met the selection criteria for a full reading. The selected studies included a total of 271 pregnant women, of which 242 underwent elective cesarean section and measurement of intra-abdominal pressure via a bladder catheter. In both pregnant women groups, the lowest intra-abdominal pressure values were found in the supine position with left lateral tilt. Prepartum values in normotensive women with singleton pregnancy (7.3±1.3 to 14.1 ± 1 mmHg) were lower than in gestational hypertensive disorders (12.0±3.3 to 18.3±2.6 mmHg). In postpartum, the values decreased in both groups but were even lower in normotensive women (3.7±0.8 to 9.9 ± 2.6 mmHg vs 8.5 ± 3.6 to 13.6 ± 3.3 mmHg). The same was true for twin pregnancies. The Sequential Organ Failure Assessment index ranged from 0.6 (0.5) to 0.9 (0.7) in both groups of pregnant women. The placental malondialdehyde levels were statistically (p < 0.05) higher in pregnant women with pre-eclampsia (2.52±1.05) than normotensive (1.42±0.54). CONCLUSIONS Prepartum intra-abdominal pressure values in normotensive women were close or equal to intra-abdominal hypertension and compatible with gestational hypertensive disorders even in the postpartum period. IAP values were consistently lower in supine position with lateral tilt in both groups. Significant correlations were found between prematurity, low birth weight, pregnant women with hypertensive disorders, and increased intra-abdominal pressure. However, there was no significant association of dysfunction in any system in the relationship between intra-abdominal pressure and Sequential Organ Failure Assessment. Despite the higher malondialdehyde values in pregnant women with pre-eclampsia, the findings were inconclusive. Given the observed data on maternal and fetal outcomes, it would be recommended that intra-abdominal pressure measurements be standardized and used as a diagnostic tool during pregnancy. TRIAL REGISTRATION PROSPERO registration: October 9th, 2020, CRD42020206526.
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Narang K, Weaver AL, Mehta RA, Garovic VD, Szymanski LM. Intraabdominal pressure as a marker for physiologic and pathologic processes in pregnancy. Hypertens Pregnancy 2022; 41:181-189. [DOI: 10.1080/10641955.2022.2085741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kavita Narang
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Amy L. Weaver
- Division of Clinical Trial and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Ramila A. Mehta
- Division of Clinical Trial and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Vesna D. Garovic
- Division of Nephrology and Hypertension, Department of Internal Medicine, and Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Linda M. Szymanski
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Gyselaers W, Lozada MJ, Pacheco LD, Tayebi S, Malbrain MLNG. Intra-abdominal pressure as an ignored parameter in the pathophysiology of preeclampsia. Acta Obstet Gynecol Scand 2020; 99:963-965. [PMID: 32683680 DOI: 10.1111/aogs.13898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Wilfried Gyselaers
- Department of Physiology, Hasselt University, Hasselt, Belgium.,Department of Obstetrics and Gynecology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - M James Lozada
- Division of Obstetric Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Luis D Pacheco
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX, USA.,Division of Critical Care Medicine, Department of Anesthesiology, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Salar Tayebi
- Department of Biomedical Engineering, Vrije Universiteit Brussel, Brussels, Belgium
| | - Manu L N G Malbrain
- Intensive Care Unit, University Hospital Brussels, Jette, Belgium.,Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
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Garg D, Tyagi A, Kumar M. Intraabdominal pressure and its relation with organ dysfunction in patients scheduled for elective cesarean section: Effect of supine vs left lateral tilt position. Acta Obstet Gynecol Scand 2020; 100:101-108. [PMID: 32726457 DOI: 10.1111/aogs.13965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/12/2020] [Accepted: 07/20/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Intraabdominal pressure (IAP) is related to clinical outcome of patients. It is measured as intravesical pressure through a Foley catheter in the supine position. During pregnancy, there are data showing elevated IAP and also a suggestion that it may be a false increase due to pressure on the urinary bladder by the gravid uterus in the supine position. Additionally, it is not known whether the elevated IAP during pregnancy is merely a physiological change or is associated with impairment of organ functions. We thus aimed to establish a normal value of IAP in supine (IAPsupine ) as well as 10° left lateral (IAPlateral-tilt ) positions, and their association with organ functions as well as certain maternal risk characteristics. MATERIAL AND METHODS This prospective cross-sectional cohort study included 100 consenting parturients with term gestation posted for elective cesarean section under single-shot subarachnoid block. IAP was measured via an indwelling Foley catheter with a transducer connected to it, as per the recommended technique. Organ dysfunction was defined as Sequential Organ Failure Assessment (SOFA) subscore ≥1 for the particular system. TRIAL REGISTRATION ctri.gov.in (CTRI/2017/11/010527). RESULTS The IAPsupine was significantly higher than IAPlateral-tilt (13.8 ± 2.4 vs 12 ± 2.3 mm Hg) (P < .001). The incidence of intraabdominal hypertension as per conventional definition, that is, IAP ≥12 mm Hg, was also higher in the supine position (77% vs 55%) (P < .001). None of the patients had dysfunction of the cardiovascular, renal or central nervous system. The incidence of respiratory, hepatic and hematologic dysfunction was 2%, 15% and 32%, respectively. Receiver operating characteristic analysis showed insignificant association of IAPsupine and IAPlateral-tilt with various organ dysfunctions (P > .05). There was a significant correlation of intraabdominal hypertension when considering IAPsupine or IAPlateral-tilt , with obesity (P = .004 and .000, respectively), as well as preeclampsia (P = .006 and .000, respectively). CONCLUSIONS In nonlaboring patients undergoing elective cesarean section, IAP is significantly higher in the supine vs 10° left lateral position. In neither position is IAP significantly associated with organ dysfunction. Thus, the usual recommendation of a supine position for measuring IAP to diagnose intraabdominal hypertension, formulated consequent to its pathological effects on organ functions, may not be applicable to pregnant patients and needs urgent validation studies.
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Affiliation(s)
- Devansh Garg
- Department of Anesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, New Delhi, India
| | - Asha Tyagi
- Department of Anesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, New Delhi, India
| | - Mahendra Kumar
- Department of Anesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, New Delhi, India
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