Kuhn J C, Falk R Sørum, Langesæter E
Department of Anaesthesiology, Critical Care and Emergencies, Bærum Hospital, Vestre Viken Health Trust, Gjettum, Norway.
Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
Int J Obstet Anesth. 2017 May;31:74-83. doi: 10.1016/j.ijoa.2017.03.003. Epub 2017 Mar 10.
There are few studies on maternal haemodynamic changes during labour. None have used continuous cardiac output monitoring during all labour stages. In this observational study, we monitored haemodynamic variables continuously during the entire course of labour in healthy parturients.
Continuous haemodynamic monitoring with the LiDCOplus technique was performed in 20 healthy parturients during spontaneous labour, vaginal delivery and for 15minutes postpartum. Cardiac output, stroke volume, heart rate, systemic vascular resistance, and systolic arterial pressure were measured longitudinally at baseline (periods between/without contractions) and during contractions in early and late stage 1, stage 2, during delivery, and postpartum, and were analysed with marginal linear models.
Twenty parturients were included. In early stage 1, baseline cardiac output was 6.3L/min (95% CI 5.7 to 6.9). Baseline values were similar across both labour stages and postpartum for all haemodynamic variables. During stage 2 contractions, cardiac output decreased by 32%, stroke volume decreased by 44%, heart rate increased by 52%, systemic vascular resistance increased by 88%, and systolic arterial pressure increased by 36% compared to baseline. During stage 1 contractions, haemodynamic changes were less profound and less uniform than during stage 2.
Progression of labour had no major effect on haemodynamic baseline values. Haemodynamic stress during contractions was substantial in both labour stages, yet most pronounced during the second stage of labour. The absence of an increase in stroke volume and cardiac output postpartum questions the common belief in an immediate rise in cardiac output after delivery due to autotransfusion from the contracted uterus.
关于分娩期间母体血流动力学变化的研究较少。尚无研究在分娩的所有阶段使用连续心输出量监测。在这项观察性研究中，我们对健康产妇分娩全过程的血流动力学变量进行了连续监测。
对20名健康产妇在自然分娩、阴道分娩及产后15分钟期间，采用LiDCOplus技术进行连续血流动力学监测。在基线期（宫缩间期/无宫缩时）以及第一产程早期和晚期、第二产程、分娩时及产后的宫缩期间，纵向测量心输出量、每搏输出量、心率、全身血管阻力和收缩压，并采用边际线性模型进行分析。
纳入20名产妇。在第一产程早期，基线心输出量为6.3L/分钟（95%置信区间5.7至6.9）。所有血流动力学变量在两个产程及产后的基线值相似。与基线相比，在第二产程宫缩期间，心输出量下降32%，每搏输出量下降44%，心率增加52%，全身血管阻力增加88%，收缩压增加36%。在第一产程宫缩期间，血流动力学变化不如第二产程明显和一致。
分娩进展对血流动力学基线值无重大影响。两个产程宫缩期间的血流动力学应激均较大，但在第二产程最为明显。产后每搏输出量和心输出量未增加，这对因子宫收缩自体输血导致产后心输出量立即增加的普遍观点提出了质疑。
