Abstract
ObjectiveTo determine intra-abdominal pressure (IAP) and to evaluate the reproducibility of IAP-measurements using the Foley Manometer Low Volume (FMLV) in term uncomplicated pregnancies before and after caesarean section (CS), relative to two different reference points and to non-pregnant values.DesignObservational cohort study.SettingSecondary level referral center for feto-maternal medicine.PopulationTerm uncomplicated pregnant women as the case-group and non-pregnant patients undergoing a laparoscopic assisted vaginal hysterectomy (LAVH) as control group.MethodsIAP was measured in 23 term pregnant patients, before and after CS and in 27 women immediately after and 1 day after LAVH. The midaxillary line was used as zero-reference (IAPMAL) in all patients and in 13 CS and 13 LAVH patients, the symphysis pubis (IAPSP) was evaluated as additional zero-reference. Intraobserver correlation (ICC) was calculated for each zero-reference. Paired student's t-tests were performed to compare IAP values and Pearson's correlation was used to assess correlations between IAP and gestational variables.Main outcome measuresICC before and after surgery, IAP before and after CS, IAP after CS and LAVH.ResultsThe ICC for IAPMAL before CS was lower than after (0.71 versus 0.87). Both mean IAPMAL and IAPSP were significantly higher before CS than after: 14.0±2.6 mmHg versus 9.8±3.0 mmHg (p<0.0001) and 8.2±2.5 mmHg versus 3.5±1.9 mmHg (p = 0.010), respectively. After CS, IAP was not different from values measured in the LAVH-group.ConclusionIAP-measurements using FMLV is reproducible in pregnant women. Before CS, IAP is increased in the range of intra-abdominal hypertension for non-pregnant individuals. IAP significantly decreases to normal values after delivery.
Highlights
Intra-abdominal pressure (IAP) was defined in 2006 by the World Society of Abdominal Compartment Syndrome (WSACS, www.wsacs.org) consensus definition as the steady state pressure concealed within the abdominal cavity [1,2]
The intra-class correlation coefficient (ICC) for IAPMAL before caesarean section (CS) was lower than after (0.71 versus 0.87). Both mean IAPMAL and IAPSP were significantly higher before CS than after: 14.062.6 mmHg versus 9.863.0 mmHg (p,0.0001) and 8.262.5 mmHg versus 3.561.9 mmHg (p = 0.010), respectively
After CS, IAP was not different from values measured in the laparoscopic assisted vaginal hysterectomy (LAVH)-group
Summary
Intra-abdominal pressure (IAP) was defined in 2006 by the World Society of Abdominal Compartment Syndrome (WSACS, www.wsacs.org) consensus definition as the steady state pressure concealed within the abdominal cavity [1,2]. A normal IAP varies from sub-atmospheric values to 7 mmHg in normalweight individuals, with higher baseline levels in morbidly obese patients of about 9 to 14 mmHg [1,3]. Intra-abdominal hypertension (IAH) is defined as a sustained increase in IAP$12 mmHg and abdominal compartment syndrome (ACS) is defined as IAP. 20 mmHg with new onset end-organ failure Both IAH and ACS are associated with organ dysfunction, multisystem organ failure, high morbidity and mortality [1,4,5,6]. Transrectal measurement of IAP was higher in pregnant women compared to non-pregnant individuals, and values increased throughout the course of pregnancy. In a few case reports, it has been recently suggested that elevated IAP might play a role in some gestational complications, such as (pre)eclampsia [8,9,10] of which the hypothesis has been documented extensively [10,11,12]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
