Hyuga S, Shishii M, Kondo H, Fujita T, Okutomi T
Division of Obstetric Anesthesia, Center for Perinatal Care, Child Health and Development, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara City, Kanagawa 252-0375, Japan.
Division of Obstetric Anesthesia, Center for Perinatal Care, Child Health and Development, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara City, Kanagawa 252-0375, Japan.
Int J Obstet Anesth. 2025 May;62:104332. doi: 10.1016/j.ijoa.2025.104332. Epub 2025 Jan 21.
The most effective lumbar pillow placement, which best enables left uterine displacement and does not interfere with cardiopulmonary resuscitation, is unclear. We aimed to examine whether changing pillow placement positions affects the degree ofpelvic and thoracic tilt for left uterine displacement in full-term pregnant women.
This prospective randomized, controlled trial included 38 healthy pregnant women at >37 weeks'gestation. The primary outcome was pelvic tilt (angle). The secondary endpoints werehemodynamic changes and thoracic tilt. The patient was placed in the supine positionand with left uterine displacement using the following methods in random order: the superior anterior iliac spine coinciding with the lower edge of the pillow (U), the middleof the pillow (M), the upper edge of the pillow (L), or tilting the bed 15° to the left without pillow placement (B). Pelvic tilt, blood pressure, heart rate, and thoracic tilt were measured and compared for each pillow position.
Patient background, blood pressure, and heart rate did not differ among the groups. Pelvic tilt was greater in groups M/L/B than in group U. Thoracic tilt was greater in group B than in all other groups and greater in group U than in groups M/L.
Aligning the pillow's center/upper edge with the right iliac spine optimizes pelvic tilt and minimizes the tilt of the rib cage. Further study is required to determine if this method contributes to effective left uterine displacement during surgery or cardiopulmonary resuscitation.
目前尚不清楚最有效的腰椎枕放置方式，即最能实现子宫左移且不干扰心肺复苏的方式。我们旨在研究改变枕头放置位置是否会影响足月孕妇子宫左移时骨盆和胸廓的倾斜程度。
这项前瞻性随机对照试验纳入了38名孕周>37周的健康孕妇。主要结局指标为骨盆倾斜度（角度）。次要终点为血流动力学变化和胸廓倾斜度。患者取仰卧位，采用以下方法随机依次进行子宫左移：髂前上棘与枕头下缘对齐（U组）、与枕头中部对齐（M组）、与枕头 上缘对齐（L组），或不放置枕头将床向左倾斜15°（B组）。测量并比较每个枕头放置位置的骨盆倾斜度、血压、心率和胸廓倾斜度。
各组间患者背景、血压和心率无差异。M/L/B组的骨盆倾斜度大于U组。B组的胸廓倾斜度大于所有其他组，U组的胸廓倾斜度大于M/L组。
将枕头的中心/上缘与右髂嵴对齐可优化骨盆倾斜度，并使胸廓倾斜度最小化。需要进一步研究以确定该方法是否有助于手术或心肺复苏期间有效的子宫左移。
