Pregnancy Related
Conditions
Keywords
pulmonary echography, B-Type natriuretic peptide, Spinal anesthesia
Brief summary
Pregnancy is characterized by many biohumoral changes: circulation, respiratory mechanics, oncotic pressure, vascular permeability and many other systems are affected. Vascular permeability is controlled by endothelial glycocalyx. Several factors such as sepsis, ischemia / reperfusion, inflammatory mediators, trauma, surgery including the Cesarean Section and fluid overload can increase vascular permeability due to a glycocalyx damage. During Cesarean Section under subarachnoid anesthesia, hypotension may occur. It is a common side effect caused by reduced preload due to aortocaval compression by the uterus. Furthermore, subarachnoid anesthesia causes block of the sympathetic preganglionic fibers which is associated with vasodilation. These changes often require the use of vasopressors and fluids. A fluid overload associated with the physiological and pathological factors discussed earlier might cause an increased risk of pulmonary edema and acute respiratory failure (IRA) in women undergoing cesarean section under arachnoid anesthesia. IRA occurs in less than 0.2% of total pregnancies but it is one of the most common cause of admission to intensive care unit in pregnant women. Among the causes that can lead to IRA in the last trimester of pregnancy we find pneumopathies such as asthma, pulmonary embolism due to amniotic fluid and pulmonary edema related to severe preeclampsia. Diagnosis of pulmonary edema can be clinical or sub-clinical through laboratory tests such as BNP (b-type natriuretic peptide). It might also be necessary to execute instrumental examinations such as chest radiography (contraindicated in pregnancy) or trans-thoracic ultrasound. Hypothesis: correlation between subarachnoid anesthesia, fluidic therapy and BNP values and ultrasound pattern
Interventions
DIAGNOSTIC_TESTB-Type natriuretic peptide (BNP) serum values
evaluation BNP serum values: * pre- Cesarean Section (30 minutes before surgery) * post- Cesarean Section (6 hour and 24 hour after surgery)
DEVICEPulmonary echography
Pulmonary echography: * pre- Cesarean Section (30 minutes before surgery) * post- Cesarean Section (6 hour and 24 hour after surgery)
OTHERurine collection
6 hour and 24 hour urine collection after Cesarean Section
Sponsors
University of Udine
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
woman submit elective Cesarean Section: * age \> 18 years * American Society of Anesthesiologists (ASA) physical status classification system \> 2 * \> 37 gestational age * arterial pressure \>/ = 140/90 mmHg and proteinuria \< 300 mmHg during anesthesia pre-examination * no known cardiovascular/respiratory disease * pre-partum pulmonary echography
Exclusion criteria
* age \< 18 years * pulmonary echographic windows not satisfying * blood loss during Cesarean Section more than 1000 mL and/or necessity to administer colloid * postpartum hemorrhage within the first 24 hours following childbirth * pre-eclamptic sign/symptoms within the first 5 days following childbirth * twin pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Ultrasound pulmonary variations | pulmonary echography is made 30 minutes before Cesarean Section, 6 and 24 hours after surgery | The main goal of our study is to evaluate, preoperatively, the incidence of ultrasound pulmonary variations in pregnant women attending elective Cesarean Section |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| subclinical pulmonary echography variation | pulmonary echography is made 30 minutes before Cesarean Section, 6 and 24 hours after surgery | Evaluating the incidence of subclinical variations in ecographic lung characteristics at 6 and 24 hours after Cesarean Section |
| B-type natriuretic peptide serum value variation | B-type natriuretic peptide serum level is sampled 30 minutes before Cesarean Section, 6 and 24 hours after surgery 30 minutes before Cesarean Section, 6 and 24 hours after surgery | Finding if there is any correlation between preoperative b-type natriuretic peptide and ecographic lung characteristics in pregnants, before and 24 hours after Cesarean Section |
| fluid administration and pulmonary echography variation | pulmonary echography is made 30 minutes before Cesarean Section, 6 and 24 hours after surgery | Finding if there is any correlation between intraoperative fluids administered and ecographic lung characteristics |
Outcome results
None listed