Sawada Masami, Yoshimatsuj Jun, Nakai Michikazu, Tsukinaga Rie, Yokouchi-Konishi Tae, Shionoiri Tadasu, Nakanishi Atsushi, Horiuchi Chinami, Tsuritani Mitsuhiro, Kamiya Chizuko A, Iwanaga Naoko, Miyamoto Yoshihiro, Nishimura Kunihiro, Ohnishi Yoshihiko
Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-chyo, Takatsuki, Osaka 569-8686, Japan.
Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shimmachi, Suita, Osaka 565-8565, Japan.
J Perinat Med. 2020 Apr 9. doi: 10.1515/jpm-2019-0348.
Background There are numerous significant physiological changes occurring in circulation during labor. To detect these rapid hemodynamic changes, invasive and intermittent measurement techniques are not reliable. To suggest a suitable delivery method for pregnancy with cardiac disease, this study analyzed how each delivery method influences cardiac function using a noninvasive and continuous measurement technique. Methods A prospective study was accomplished at the National Cerebral and Cardiovascular Center in Japan from October 1, 2014, to November 30, 2018. The classification of the healthy heart pregnant women was according to the delivery method: vaginal delivery (VD) without epidural anesthesia, VD with epidural anesthesia, and caesarean section (CS). The hemodynamic parameters cardiac index (CI), stroke volume index (SI), and heart rate (HR) were evaluated regularly throughout delivery by noninvasive electrical cardiometry monitor. Results Ten cases were examined for each group. CI and HR were significantly increased before VD, while the increase in CI and HR was mild in the epidural group in comparison to the nonepidural group. SI was increased toward the delivery in the epidural group, and it was constant in the nonepidural group. However, there was no alteration in the level of outcomes of the two groups. In CS, SI increased and HR decreased before delivery. After delivery, SI continued to increase, while HR did not change but CI increased. Conclusion In VD, the increase in venous circulation according to the autotransfusion is managed by increasing HR. By epidural anesthesia, the increase in HR was suppressed and SI was increased. However, as epidural anesthesia increases the vascular capacity, the level of SI outcome was comparable. In CS, the HR was decreased because of the spinal anesthesia and the SI was increased because of many factors like hydration. As there are many factors to control in CS, VD with epidural anesthesia will be the first preference for most cardiac patients.
分娩过程中循环系统会发生许多显著的生理变化。要检测这些快速的血流动力学变化，有创和间歇性测量技术并不可靠。为了为患有心脏病的孕妇推荐合适的分娩方式，本研究使用无创连续测量技术分析了每种分娩方式如何影响心脏功能。
2014年10月1日至2018年11月30日在日本国立脑与心血管中心进行了一项前瞻性研究。健康心脏孕妇根据分娩方式分类：无硬膜外麻醉的阴道分娩（VD）、有硬膜外麻醉的VD和剖宫产（CS）。在整个分娩过程中，通过无创心电监测仪定期评估血流动力学参数心脏指数（CI）、每搏量指数（SI）和心率（HR）。
每组检查10例。VD前CI和HR显著增加，而与无硬膜外麻醉组相比，硬膜外麻醉组CI和HR的增加较为轻微。硬膜外麻醉组SI在分娩时增加，无硬膜外麻醉组则保持不变。然而，两组的结局水平没有改变。在CS中，分娩前SI增加而HR下降。分娩后，SI继续增加，而HR没有变化，但CI增加。
在VD中，通过增加HR来管理因自身输血导致的静脉循环增加。通过硬膜外麻醉，HR的增加受到抑制，SI增加。然而，由于硬膜外麻醉增加了血管容量，SI结局水平相当。在CS中，由于脊髓麻醉HR下降，由于补液等多种因素SI增加。由于CS中有许多因素需要控制，对于大多数心脏病患者，硬膜外麻醉的VD将是首选。
