Maternal Hemodynamics Research Articles

Evaluation of the effects of prespinal administration of Ondansetron on maternal hemodynamics

Introduction: Spinal anaesthesia is the preferred method of anaesthesia for elective lower segment caesarean section (LSCS). It has a shorter onset time, but is associated with hypotension and bradycardia,which at times may be deleterious to both mother and fetus. Aim of Study: To evaluate the effects of intravenous administration of ondansetron prior to spinal anaesthesia on the hemodynamic responses in the mother specifically hypotension and bradycardia. Materials and Methods: The study was a hospital based prospective, double-blinded, randomized, placebo controlled study in our teaching medical college and hospital over a period of 6 months –February to July 2015.As per inclusion and exclusion criteria of our study, study population ( 72 patients) was identified who were planned for elective LSCS. They were randomly allocated into two groups. 5 minutes prior to spinal anaesthesia, group O (n =36) received 4mg IV Ondansetron and group P (n = 36) received physiological saline. Blood pressure and heart rate were monitored once in 5 minutes for 30 minutes, and requirement of vasopressors was noted. Results: Hypotension was significantly lower in group O when compared to group P. Bradycardia was less in number in group O but it was statistically insignificant. Vasopressor requirement was also lower in group O patients.Conclusion: Intravenous Ondansetron 4mg given 5 minutes prior to spinal anaesthesia significantly reduces the hypotension. The episodes of bradycardia as well as the requirement of vasopressors in parturients were low in ondansetron group, which was found to be statistically insignificant, may be due to less number of study population.

A randomized trial comparing prophylactic phenylephrine and ephedrine infusion during spinal anesthesia for emergency cesarean delivery in cases of acute fetal compromise

BackgroundPrevious evidence showed that use of phenylephrine was associated with higher umbilical artery pH (UA pH) than ephedrine after elective cesarean delivery (CD). However, the best choice of vasopressor and its effect on funic gases in cases of acute fetal compromise require additional studies. MethodsNinety parturients showing acute fetal compromise during intrapartum period and taken up for CD (category II) under spinal anesthesia were randomized to receive prophylactic infusion of ephedrine 2.5mg/min or phenylephrine 30μg/min. Systolic blood pressure was targeted between 90% and 110% of baseline. Incidence of fetal acidosis (UA pH <7.2 and/or base deficit >12mmol/L) was recorded. Other parameters of cord gases, Apgar score, need for immediate resuscitation, maternal hemodynamics, and adverse events were also compared. ResultsNumber of neonates showing acidosis with ephedrine or phenylephrine was comparable (P=.22). Of these, newborns with base deficit >12mmol had low 1-minute Apgar scores (n=15/23). The ephedrine group had higher oxygen content in UA (P=.03). There was no adverse neonatal outcome during the period of observation. Incidence of maternal nausea and vomiting was higher with ephedrine than with phenylephrine (22.2% vs 4.4%; P=.02). Maternal bradycardia was observed with phenylephrine (P=.02). ConclusionOur data report similar fetal acidosis with either phenylephrine or ephedrine administered during spinal anesthesia for treating maternal hypotension in cases of emergency CD.

Pregnancy-associated adaptations in [Ca2+]i-dependent and Ca2+ sensitization mechanisms of venous contraction: implications in pregnancy-related venous disorders.

Pregnancy is associated with significant adaptations in the maternal hemodynamics and arterial circulation, but the changes in the venous mechanisms during pregnancy are less clear. We hypothesized that pregnancy is associated with alterations in venous function, intracellular free Ca(2+) concentration ([Ca(2+)]i), and Ca(2+)-dependent mechanisms of venous contraction. Circular segments of inferior vena cava (IVC) from virgin and late pregnant (Preg, day 19) Sprague-Dawley rats were suspended between two hooks, labeled with fura-2, and placed in a cuvet inside a spectrofluorometer for simultaneous measurement of contraction and [Ca(2+)]i (fura-2 340/380 ratio). KCl (96 mM), which stimulates Ca(2+) influx, caused less contraction (35.6 ± 6.3 vs. 92.6 ± 19.9 mg/mg tissue) and smaller increases in [Ca(2+)]i (1.67 ± 0.12 vs. 2.19 ± 0.11) in Preg vs. virgin rat IVC. The α-adrenergic receptor agonist phenylephrine (Phe; 10(-5) M) caused less contraction (23.8 ± 3.4 vs. 70.9 ± 12.9 mg/mg tissue) and comparable increases in [Ca(2+)]i (1.76 ± 0.10 vs. 1.89 ± 0.08) in Preg vs. virgin rat IVC. At increasing extracellular Ca(2+) concentrations ([Ca(2+)]e) (0.1, 0.3, 0.6, 1, and 2.5 mM), KCl and Phe induced [Ca(2+)]e-contraction and [Ca(2+)]e-[Ca(2+)]i curves that were reduced in Preg vs. virgin IVC, supporting reduced Ca(2+) entry mechanisms. The [Ca(2+)]e-contraction and [Ca(2+)]e-[Ca(2+)]i curves were used to construct the [Ca(2+)]i-contraction relationship. Despite reduced contraction and [Ca(2+)]i in Preg IVC, the Phe-induced [Ca(2+)]i-contraction relationship was greater than that of KCl and was enhanced in Preg vs. virgin IVC, suggesting parallel activation of Ca(2+)-sensitization pathways. The Ca(2+) channel blocker diltiazem, protein kinase C (PKC) inhibitor GF-109203X, and Rho-kinase (ROCK) inhibitor Y27632 inhibited KCl- and Phe-induced contraction and abolished the shift in the Phe [Ca(2+)]i-contraction relationship in Preg IVC, suggesting an interplay between the decrease in Ca(2+) influx and possible compensatory activation of PKC- and ROCK-mediated Ca(2+)-sensitization pathways. The reduced [Ca(2+)]i and [Ca(2+)]i-dependent contraction in Preg rat IVC, despite the parallel rescue activation of Ca(2+)-sensitization pathways, suggests that the observed reduction in [Ca(2+)]i-dependent contraction mechanisms is likely underestimated, and that the veins without the rescue Ca(2+)-sensitization pathways could be even more prone to dilation during pregnancy. These pregnancy-associated reductions in Ca(2+) entry-dependent mechanisms of venous contraction, if occurring in human lower extremity veins and if not adequately compensated by Ca(2+)-sensitization pathways, may play a role in pregnancy-related venous disorders.

Ultrasound guided continuous transversus abdominis plane block for postoperative analgesia after caesarean delivery in a patient with Wolff-Parkinson-White syndrome

Ultrasound-guided transversus abdominis plane block is an extremely attractive technique ensuring adequate perioperative analgesia. The use of ultrasound has enhanced the accuracy of local anaesthetic deposition in the plane between internal oblique and transversus abdominis, thereby blocking the spinal nerves more effectively and hence enhancing the efficacy of analgesia. Pregnancy is associated with higher frequency of arrhythmias in Wolff-Parkinson-White syndrome and poor perioperative pain management may contribute to life threatening arrhythmias. We report a case of Wolff-Parkinson-White syndrome posted for elective caesarean section, managed successfully under regional anesthesia with transverses abdominis plane block. The block and catheter were deposited under ultrasound guidance with continuous infusion of 0.2% of ropivacaine was used for postoperative pain relief. Dexmetedomidine was also used as intravenous adjunct at titrated dose of 0.4-0.6 mics/kg/min to attenuate maternal hormonal and hemodynamics during surgery.

Maternal ethnicity and its impact on the haemodynamic and blood pressure response to labetalol for the treatment of antenatal hypertension

ObjectiveBlood pressure (BP) control outside pregnancy is associated with a reduction in adverse cardiovascular events, and in pregnancy with improved outcomes. Outside pregnancy, there is evidence β-blockers are less effective...

Comparison of different doses of Fentanyl for prevention of hemodynamic changes during induction and intubation in parturients undergoing caesarian section under general anesthesia.

Introduction: Present study was designed to find low, safe and efficacious dose of fentanyl to avoid its foetal side effects by comparing two doses of fentanyl to prevent haemodynamic hazards at induction and intubation in patients undergoing caesarean section (CS) under general anaesthesia (GA). Method: Forty five full term parturients posted for emergency/elective caesarean section under GA of ASA Grade I or II, age group between 18 to 35 years were randomly distributed into three groups. Intravenous fentanyl 0.5µg/kg or1µg/kg diluted to 5 ml or normal saline 5 ml was administered three minutes before induction in Group F 0.5, Group F1or Group C respectively. Maternal haemodynamic parameters and foetal parameters were recorded at different time intervals. Results: Group F and Group F1 showed significant reduction and stability in maternal haemodynamics when compared with the control group, but no statistical difference was observed amongst them. No difference was observed in foetal Apgar score and cord blood pH in all three groups. Conclusion: Fentanyl in doses as low as 0.5µg/kg can be used safely in parturients to prevent haemodynamic hazards at intubation in patients undergoing CS under GA.

Maternal demographics and hemodynamics for the prediction of fetal growth restriction at booking, in pregnancies at high risk for placental insufficiency.

Fetal growth restriction (FGR) is associated with poor perinatal outcomes. Screening and prevention tools for FGR, such as uterine artery Doppler imaging and aspirin, underperform in high-risk groups, compared with general antenatal populations. There is a paucity of sensitive screening tests for the early prediction of FGR in high-risk pregnancies. This was a prospective observational study based in a dedicated antenatal hypertension clinic at a tertiary UK hospital. We assessed maternal demographic and central hemodynamic variables as predictors for FGR in a group of women at high risk for placental insufficiency due to chronic hypertension (n = 55) or a history of hypertension in a previous pregnancy (n = 71). Outcome variables were birthweight z-score as well as development of FGR (defined as birthweight below the 5th or 3rd centile). Maternal hemodynamics were assessed using a noninvasive transthoracic bioreactance monitor (Cheetah NICOM). The mean gestation at presentation was 13.6 (range: 8.5-19.5) weeks. Sixteen women delivered babies below the 5th centile. Ten of these were below the 3rd centile. Independent predictors of birthweight z-score were body surface area, peripheral vascular resistance and white ethnicity (R(2) = 0.26, p < 0.0001). Independent predictors of FGR were maternal height and cardiac output. The area under the receiver operator characteristic curve for prediction of FGR was 0.915 (95% CI 0.859-0.972) and 0.9079 (95% CI 0.823-0.990) for FGR below the 5th and 3rd centiles, respectively. In women with chronic hypertension or a history of hypertension in a previous pregnancy, maternal size and cardiac output at booking provide a sensitive screening tool for FGR.

A comparative study of isometric handgrip test between pregnant and non-pregnant women

Background: Pregnancy is associated with profound adaptive changes in maternal haemodynamics. The incidence of Pregnancy Induced Hypertension [PIH] is one of the three main causes of maternal – neonatal morbidity and mortality is 5-7% and prediction of this disorder is very important in maternal and neonatal health. Objective: To study the effect of Isometric handrip test among pregnant (women of first trimester) and non-pregnant women. Materials and Methods: Healthy singleton pregnant women of first trimester and healthy non-pregnant women in the age group of 19 to 29 years were selected for the study. The Isometric handgrip test was performed on singleton pregnant women attending the antenatal clinic of District Civil Hospital BIMS Belagavi. The control group consisted of Medical students and Patient’s attenders of same age group. Blood pressure was measured three times before the procedure and at 1 minute intervals during handgrip. Results: The basal Diastolic blood pressure of first trimester subjects was significantly higher than compared to controls. Statistical Analysis: Student’s ‘t’ test was used. Conclusion: The study concludes that the increased basal DBP of first trimester subjects was due to the increased peripheral resistance in pregnancy. Keywords: Diastolic blood pressure, Isometric Handgrip test, Pregnant women

476: Maternal cardiac hemodynamics in normotensive vs. pregnancies with preeclampsia--did we find a helpful tool?

476: Maternal cardiac hemodynamics in normotensive vs. pregnancies with preeclampsia--did we find a helpful tool?

Maternal and Neonatal Effects of Remifentanil in Women Undergoing Cesarean Section in Relation to ABCB1 and OPRM1 Polymorphisms

The aim of our study was to evaluate possible effect of ABCB1, and OPRM1 polymorphisms on the efficacy and safety of remifentanil in women undergoing elective cesarean section under general anesthesia. Women received remifentanil (1 µg/kg i.v.) 30 s prior to the induction to standardized general anesthesia. The ABCB1 (rs2032582, rs1045642) and OPRM1 (rs1799971) polymorphisms were analyzed from maternal peripheral blood. The basal hemodynamic and demographic parameters in the study population (n=54) were similar in all the subgroups. The median ± SD increase of systolic blood pressure at 5 min from the baseline was practically completely abolished in homozygous carriers of ABCB1 variants in comparison with wild-type subjects -2.67±25.0 vs. 16.57±15.7 mm Hg, p&lt;0.05 for rs2032582, and 2.00±23.9 vs. 22.13±16.8 mm Hg, p&lt;0.05, for rs1045642, respectively. While no neonate belonging to ABCB1 wild-type homozygous or OPRM1 variant carrying mothers needed any resuscitative measure, 10.5 % of the neonates belonging to OPRM1 wild-type homozygous mothers received resuscitative support similarly as 11.1 %, and 12.5 % of neonates of mothers carrying variants of rs2032582, and rs1045642, respectively. Decreased stabilizing effects of remifentanil on maternal hemodynamics has been observed in ABCB1 wild type mothers, while the adaptation of the neonates was clinically worse in OPRM1 wild type, and ABCB1 variant allele carriers.

Maternal and neonatal effects of remifentanil in women undergoing cesarean section in relation to ABCB1 and OPRM1 polymorphisms.

The aim of our study was to evaluate possible effect of ABCB1, and OPRM1 polymorphisms on the efficacy and safety of remifentanil in women undergoing elective cesarean section under general anesthesia. Women received remifentanil (1 microg/kg i.v.) 30 s prior to the induction to standardized general anesthesia. The ABCB1 (rs2032582, rs1045642) and OPRM1 (rs1799971) polymorphisms were analyzed from maternal peripheral blood. The basal hemodynamic and demographic parameters in the study population (n=54) were similar in all the subgroups. The median +/- SD increase of systolic blood pressure at 5 min from the baseline was practically completely abolished in homozygous carriers of ABCB1 variants in comparison with wild-type subjects -2.67+/-25.0 vs. 16.57+/-15.7 mm Hg, p<0.05 for rs2032582, and 2.00+/-23.9 vs. 22.13+/-16.8 mm Hg, p<0.05, for rs1045642, respectively. While no neonate belonging to ABCB1 wild-type homozygous or OPRM1 variant carrying mothers needed any resuscitative measure, 10.5 % of the neonates belonging to OPRM1 wild-type homozygous mothers received resuscitative support similarly as 11.1 %, and 12.5 % of neonates of mothers carrying variants of rs2032582, and rs1045642, respectively. Decreased stabilizing effects of remifentanil on maternal hemodynamics has been observed in ABCB1 wild type mothers, while the adaptation of the neonates was clinically worse in OPRM1 wild type, and ABCB1 variant allele carriers.

Analysis of maternal intracardiac hemodynamics and fetoplacental blood flow in women with myocarditis

In purpose of to estimate of the central hemodynamics and feto-placentary complex condition at pregnant with myocarditis 128 pregnant with myocarditis aged about 17–40 years were studied. Received results are shown, that at 68.5 % women with myocarditis the strike fraction (SF) was increased (> 70 %). At women with high SF (SF >70 %) in 64 % cases there are revealed failure of blood groove in uterine arteries, in 18 % cases — failure in placental blood groove and in 12 % cases failure of maternal-placentary blood groove.

A retrospective study to correlate breech presentation and enhanced risk of postspinal hypotension during cesarean delivery.

BackgroundSubarachnoid blockade for cesarean section still poses a threat of profound hypotension and can result in unstable maternal and fetal hemodynamics. The correlation of fetal breech and vertex presentation with the occurrence of hypotension under spinal anesthesia is reviewed in this retrospective, double-blind study.Patients and methodsThe study was conducted on pregnant females scheduled for a lower segment cesarean section between January 2014 and December 2014. After applying inclusion criteria, 568 patients were recruited in the study out of which 363 had vertex and 184 patients had breech presentation. They were divided into two groups, Group I and Group II. The monitoring and therapeutic data (blood pressure, heart rate, arterial oxygen saturation, and dose of vasopressor/atropine) recovered from automated data analysis were analyzed retrospectively for prevalence of hypotension, bradycardia, and hypotension with bradycardia and nausea ± vomiting.ResultsAmong Group I, prevalence of hypotension, bradycardia, and hypotension together with bradycardia was 152 (41.83%) patients, eight (2.20%) patients, and seven (1.92%) patients, respectively. In Group II, the prevalence of hypotension, bradycardia, and hypotension with bradycardia was 93 (50.5%) patients, five (2.71%) patients, and six (3.2%) patients, respectively. The difference between the two groups was statistically significant for hypotension. For Group I, 152 patients (41.87%) experienced one, 23 patients (6.33%) experienced two, and three patients (0.82%) experienced three episodes of hypotension. In Group II, 93 (50.5%), 19 (7.89%), and two (1.08%) patients experienced such episodes. The difference was significant with respect of one and two episodes. The prevalence of intraoperative nausea was 11.01% (40 patients) in Group I, whereas 11.41% (21 patients) in Group II. Intraoperative vomiting occurred in 19 patients (5.23%) of Group I and 14 patients (7.60%) of Group II. The height of the block was comparable in both the groups for T6, and the difference was significant in respect to T4 level.ConclusionIncidence of hypotension is more in pregnant females with breech fetal presentation.

Maternal functional hemodynamics in the second half of pregnancy: a longitudinal study.

ObjectiveCardiovascular response to passive leg raising (PLR) is useful in assessing preload reserve, but it has not been studied longitudinally during pregnancy. We aimed to investigate gestational age associated serial changes in maternal functional hemodynamics and establish longitudinal reference ranges for the second half of pregnancy.Materials and MethodsThis was a prospective longitudinal study on 98 healthy pregnant women who were examined 3–5 times during 20–40 weeks of gestation (a total of 441 observations). Maternal cardiac function and systemic hemodynamics were assessed at baseline and 90 seconds after PLR using impedance cardiography (ICG). The main outcome measures were gestational age specific changes in ICG-derived variables of maternal cardiovascular function and functional hemodynamic response to PLR.ResultsHemodynamic response to PLR varied during pregnancy. PLR led to an insignificant increase in stroke volume during 20+0 to 31+6 weeks, but later in gestation the stroke volume was slightly lower at PLR compared to baseline. PLR caused no significant change in cardiac output between 20+0 and 23+6 weeks and a significant decrease after 24+0 weeks. A decrease in heart rate, mean arterial pressure, and cardiac contractility was observed during PLR throughout the second half of pregnancy. Systemic vascular resistance was reduced by PLR up to 32+0 weeks, but increased slightly thereafter.ConclusionHealthy pregnant women appear to have limited preload reserve and reduced cardiac contractility, especially in the third trimester, which makes them vulnerable to fluid overload and cardiac failure.

Maternal and fetal arterial blood gas data during general anaesthesia for caesarean delivery of preterm twin lambs.

Much remains to be understood with regards the effects of prolonged anaesthesia on maternal and fetal haemodynamics and oxygenation. With the aim of improving anaesthetic management of pregnant sheep undergoing recovery surgery under anaesthesia, paired maternal and fetal arterial blood samples were collected during caesarean delivery of twin preterm lambs to document the blood gas status of the ewe and fetus. Twenty-one Merino twin pregnant ewes at 126 (±1) days of gestation were anaesthetized for caesarean delivery of their fetuses. Arterial blood samples were collected from the radial artery of the ewe and umbilical artery of the fetus at the point of delivery. There was a significant difference between maternal PaCO2 and end-tidal CO2 and alveolar and arterial PaO2, indicating ventilation perfusion mismatch. Interestingly, the ewes were anaemic but the fetuses were not. These data underscore the need to undertake further work to determine the optimal anaesthetic regimen for twin pregnant ewes at different gestational ages in a biomedical research setting.

A Randomized, Double-blinded Trial of a “Rule of Threes” Algorithm versus Continuous Infusion of Oxytocin during Elective Cesarean Delivery

The administration of uterotonic agents during cesarean delivery is highly variable. The authors hypothesized a "rule of threes" algorithm, featuring oxytocin 3 IU, timed uterine tone evaluations, and a systematic approach to alternative uterotonic agents, would reduce the oxytocin dose required to obtain adequate uterine tone. Sixty women undergoing elective cesarean delivery were randomized to receive a low-dose bolus or continuous infusion of oxytocin. To blind participants, the rule group simultaneously received intravenous oxytocin (3 IU/3 ml) and a "wide-open" infusion of 0.9% normal saline (500 ml); the standard care group received intravenous 0.9% normal saline (3 ml) and a "wide-open" infusion of oxytocin (30 IU in 0.9% normal saline/500 ml). Uterine tone was assessed at 3, 6, 9, and 12 min, and if inadequate, additional uterotonic agents were administered. Uterine tone, total dose and timing of uterotonic agent use, maternal hemodynamics, side effects, and blood loss were recorded. Adequate uterine tone was achieved with lower oxytocin doses in the rule versus standard care group (mean, 4.0 vs. 8.4 IU; point estimate of the difference, 4.4 ± 1.0 IU; 95% CI, 2.60 to 6.15; P < 0.0001). No additional oxytocin or alternative uterotonic agents were needed in either group after 6 min. No differences in the uterine tone, maternal hemodynamics, side effects, or blood loss were observed. A "rule of threes" algorithm using oxytocin 3 IU results in lower oxytocin doses when compared with continuous-infusion oxytocin in women undergoing elective cesarean delivery.

O61. The treatment of antenatal hypertension with labetalol: A prediction model for successful response

Introduction The aim of this study was to create and validate a prediction model for the response to labetalol in women who have hypertension in pregnancy. This prediction model is based on maternal demographics and haemodynamics. Methods This was a prospective observational study that ran over three phases. In the first phase, 50 women attending King's College Hospital's antenatal hypertension clinic, needing antihypertensive treatment, were commenced on labetalol and followed to delivery. We recorded maternal demographics and haemodynamic characteristics at presentation and created a prediction model for the successful treatment with labetalol. In the second phase, this model was internally validated, with a further 50 patients who were treated with either labetalol or alternatively, a vasodilator, based on their haemodynamics at presentation and with reference to our prediction model. In the third phase, we monitored 50 patients' haemodynamics serially, and we adjusted antihypertensive treatment at each visit according to our prediction model. Outcome measures: the prevalence of severe pre-eclampsia (PE) over the three phases of the study. Statistics: multivariate logistic regression with bootstrapping and the χ 2 -test and χ 2 -for-trend. Results In the first study, 50 patients were treated with labetalol. Of these 37 (74%) responded and 13 (26%) did not, despite dose maximisation. From the non-responders 10 (77%) were admitted with severe pre-eclampsia whilst from the responders only 1 was admitted (3%) ( χ 2 - p 0.001). A prediction model for the response to labetalol was created. The area under the receiver operating characteristic curve was 0.9626 and this was confirmed in the validation study. Using the prediction model to guide treatment, the PE rate fell from 20% to 10% and 6%, respectively over the three phases of the study ( χ 2 for trend p 0.001). Conclusion Maternal demographics and haemodynamics can provide a sensitive prediction tool to anticipate the response to labetalol in hypertensive pregnancies, with a subsequent reduction in severe pre-eclampsia rates

O111. The association between maternal haemodynamics and pre-eclampsia: Systematic review and meta-analysis

Objective Pre-eclampsia (PE) is associated with marked maternal cardiovascular changes before its clinical onset, at the time of clinical diagnosis, and in the postpartum period. These changes vary according to the timing of onset (early vs late) or the severity (mild vs severe) of PE.The aim of this study was to perform a systematic review and meta-analysis to quantify these cardiovascular changes associated with PE. Methods MEDLINE, EMBASE, CINAHL and The Cochrane Library were searched, using combinations of the terms pre-eclampsia, cardiac, vascular resistance, stroke volume (SV) and pregnancy hypertension. Reference lists within relevant articles and reviews were hand-searched for additional reports. Randomised controlled trials, cohort and case-control studies were included. Studies reporting data on cardiac output (CO), cardiac index (CI), SV, systemic vascular resistance (SVR) and its index (SVRI) were included. Between-study heterogeneity was assessed using the I 2 test. Results The search yielded 1943 citations, of which 56 studies were included in the review. A significant increase in SVR (weighted mean difference [WMD] 446.42, p p p p p p p =0.002) and SVR (WMD 317.33, p =0.004) were significantly lower, while the SV (WMD −9.00, p =0.002) was significantly higher after the incident pregnancy (postpartum), when complicated by PE. Conclusion Women who develop PE have significantly elevated SVR, both at the time of the clinical diagnosis and postpartum. SV may also be useful in first trimester screening for PE. However, changes in CO were not significantly different in PE before its clinical onset, at the time of diagnosis, or postpartum.

The Effect of Intravenous Ondansetron on Maternal Hemodynamics During Elective Cesarean Delivery Under Spinal Anesthesia

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Respiratory disease in pregnancy

Many physiological and anatomical changes of pregnancy affect the respiratory system. These changes often affect the presentation and management of the various respiratory illnesses in pregnancy. This article focuses on several important respiratory issues in pregnancy. The management of asthma, one of the most common chronic illnesses in pregnancy, remains largely unchanged compared to the nonpregnant state. Infectious respiratory illness, including pneumonia and tuberculosis, are similarly managed in pregnancy with antibiotics, although special attention may be needed for antibiotic choices with more pregnancy safety data. When mechanical ventilation is necessary, consideration should be given to the maternal hemodynamics of pregnancy and fetal oxygenation. Maintaining maternal oxygen saturation above 95% is recommended to sustain optimal fetal oxygenation. Cigarette smoking has known risks in pregnancy, and current practice guidelines recommend offering cognitive and pharmacologic interventions to pregnant women to assist in smoking cessation.