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Haemodynamic changes associated with caesarean section under epidural anaesthesia.

S C Robson1, W Dunlop, S Hunter

  • 1Department of Obstetrics, University of Newcastle, Princess Mary Maternity Hospital, Newcastle Upon Tyne.

British Journal of Obstetrics and Gynaecology
|June 1, 1989
PubMed
Summary

Epidural anesthesia for cesarean delivery initially preserves hemodynamics. Post-delivery, cardiac output and stroke volume temporarily increase, then decline significantly by two weeks, impacting maternal cardiovascular recovery.

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Area of Science:

  • Cardiovascular Physiology
  • Anesthesiology
  • Obstetrics

Background:

  • Cesarean delivery is a common surgical procedure.
  • Epidural anesthesia is frequently used for pain management during cesarean delivery.
  • Understanding the hemodynamic effects of epidural anesthesia and delivery is crucial for maternal care.

Purpose of the Study:

  • To investigate serial hemodynamic changes in women undergoing elective cesarean delivery under epidural anesthesia.
  • To assess the impact of anesthesia and delivery on cardiac output, stroke volume, heart rate, and blood pressure.
  • To evaluate the postpartum cardiovascular recovery trajectory.

Main Methods:

  • Serial hemodynamic measurements were performed in 15 women.
  • Elective cesarean section was conducted under epidural anesthesia.

Related Experiment Videos

  • Cardiac output and stroke volume were measured using Doppler and echocardiography at the aortic valve.
  • Measurements were taken pre-operatively, during surgery, and at various postpartum intervals (1st day, 2nd-6th days, 2 weeks).

    • Main Results:

    • No immediate hemodynamic changes were observed after achieving surgical anesthesia (T5 or above).
    • Stroke volume increased by 13% post-placental delivery, with cardiac output 11% higher than pre-operative values at the end of surgery.
    • Stroke volume and cardiac output decreased on the first postoperative day.
    • Heart rate remained elevated for 48 hours postpartum, then fell between days 2 and 6.
    • Cardiac output was 28% lower than pre-operative values by 2 weeks postpartum.
    • Diastolic blood pressure was lower on the first and second postnatal days compared to pre-operative values.

    Conclusions:

    • Epidural anesthesia for cesarean delivery does not cause immediate hemodynamic compromise.
    • A transient increase in cardiac output occurs post-delivery, followed by a significant decline in the early postpartum period.
    • Maternal cardiovascular function, particularly cardiac output, shows a notable reduction by two weeks postpartum, suggesting a prolonged recovery phase.