Abstract and Introduction
During cesarean delivery with neuraxial anesthesia, maternal hemodynamic changes occur with prehydration of intravenous fluid, block onset and delivery of the fetus. The direction and degree of these hemodynamic changes is influenced by multiple interacting variables including the physiologic and anatomic alterations of pregnancy, maternal and fetal characteristics, comorbid conditions, the neuraxial technique, the amount of blood loss and fluid and drug administration. In this review, the influences of each of these variables, as well as the techniques used to evaluate, prevent and treat hypotension, are discussed to provide a comprehensive overview of the cardiovascular alterations in the parturient undergoing cesarean delivery with neuraxial anesthesia.
The rate of cesarean delivery (CD) in the USA has increased from 4.5% in 1965 to 32.3% in 2008. In many developed countries, the use of neuraxial anesthesia, including epidural, spinal and combined spinal–epidural techniques, is used to perform an estimated average of 90–95% of CDs.[2,3–5] Maternal and fetal characteristics, comorbid conditions, the physiologic and anatomic alterations of pregnancy, fluid and drug administration, and the impact of surgery and neuraxial anesthesia can result in numerous interacting cardiovascular responses. The purpose of this review is to provide a comprehensive overview of the cardiovascular alterations in the parturient undergoing CD with neuraxial anesthesia.
The direction and degree of hemodynamic changes throughout pregnancy and during CD under neuraxial anesthesia will be examined. In addition, the general modalities used to evaluate these cardiovascular changes will be reviewed, along with the specific hemodynamic concerns present in parturients with preeclampsia and multifetal gestations. Finally, the most current methods to prevent and treat spinal-induced hypotension will be discussed.
Expert Rev of Obstet Gynecol. 2012;7(1):59-75. © 2012 Expert Reviews Ltd.