Abstract
Background Enlarged uterus can compress the inferior vena cava and cause hypotension when lying supine. Previous studies have shown a positive association between the abdominal circumference and size of the uterus. Therefore, the aim of this study was to evaluate the relationship between abdominal circumference and incidence of hypotension during cesarean section under spinal anesthesia. Methods The study cohort comprised women undergoing cesarean section under spinal anesthesia. Patients were divided into two groups according to the median abdominal circumference (<101 cm and ≥101 cm). Hypotension was defined as a systolic blood pressure of <90 mmHg or mean arterial pressure of <65 mmHg. The primary outcome of this study was the relationship between the incidence of hypotension and the abdominal circumference after spinal anesthesia in term pregnant women. Results The study cohort comprised 100 women. The incidence of hypotension did not differ between the groups (71.42% in the smaller vs. 78.43% in the larger abdominal circumference group, p=0.419). However, the decrease in mean arterial pressure and its percentage decrease from baseline were greater in the larger than in the smaller abdominal circumference group (change in mean arterial pressure: 28.33 mmHg (18.66–33.67) in the smaller vs. 36.67 mmHg (23.34–43.34) in the larger abdominal circumference group, p=0.004; percentage decrease: 31.41% (22.74–39.22) in the smaller vs. 38.47% (28.00–44.81) in the larger abdominal circumference group, p=0.022). Conclusions Large abdominal circumference in pregnancy is associated with greater decreases in mean arterial pressure from baseline. However, the incidence of hypotension defined by standard criteria did not differ between larger and smaller abdominal circumference groups.
Highlights
A high level of sensory block after spinal anesthesia increases the incidence of hypotension in pregnant women [1]
We hypothesized that the increased abdominal circumference (AC), which was previously found to be associated with the increased abdominal pressure and the enlarged uterus, was related to the increased incidence of hypotension after spinal anesthesia. e aim of this study was to evaluate the relationship between the AC and incidence of hypotension during cesarean section under spinal anesthesia
A total of 49 cases were in the smaller AC group and 51 cases were in the larger AC group. e patient characteristics were similar in the two groups except for age, the patients being older, and the neonatal weight greater in the larger AC group (Table 1). e anesthetic level was tested and recorded until the skin was incised. e proportion of patients who had anesthetic level other than T4 before skin incision did not differ between groups
Summary
A high level of sensory block after spinal anesthesia increases the incidence of hypotension in pregnant women [1]. Erefore, it is rational to use AC as a surrogate for abdominal pressure in this study Another explanation for hypotension after spinal anesthesia is supine hypotensive syndrome, which is when hypotension while lying supine results from the enlarged uterus directly compressing the inferior vena cava and descending aorta. We hypothesized that the increased AC, which was previously found to be associated with the increased abdominal pressure and the enlarged uterus, was related to the increased incidence of hypotension after spinal anesthesia. Erefore, the aim of this study was to evaluate the relationship between abdominal circumference and incidence of hypotension during cesarean section under spinal anesthesia. Hypotension was defined as a systolic blood pressure of
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