Vaishali C. Shelgaonkar1, Sandhya P. Manjrekar2, Jaideep Sonowal3
ABSTRACT: BACKGROUND: Pregnancy is a state of dramatic haemodynamic changes to accommodate the increasing needs of a pregnant body. These changes can be further complicated by preeclampsia which occurs in 6-12% of all pregnancies, showing varied haemodynamic profiles, making it difficult for the clinicians to plan a goal directed management or therapy plan. These patients posted for caesarean section under spinal anaesthesia management become more challenging. AIMS: To evaluate NICOM, based on bioreactance, as an aid to assess the haemodynamic changes in normal & pregnancy induced hypertensive (PIH) parturient during elective caesarean delivery under SAB. Also to assess the utility of NICOM, to determine haemodynamic variation, response to intravenous fluids or drugs & to compare fluctuations in cardiac output. SETTINGS & DESIGN: This prospective observational cohort study was carried out on 80 antenatal patients after dividing in Normotensive /group N or Hypertensive parturients/ group H undergoing elective caesarean section under spinal anaesthesia. METHODS: Perioperatively haemodynamic variables including systolic (SBP), diastolic (DPB), mean arterial (MAP) pressures, heart rate (HR), stroke volume (SV), total peripheral resistance (TPR) & cardiac output (CO) were monitored continuously by NICOM. STATISTICAL ANALYSIS: All data were analyzed by specific statistical methods (Chi Square, t-Test, Z-test, Fisher's exact test and Yates' correction) where ever applicable. RESULTS: There were significant fluctuations noted in SBP, HR and CO after SAB in spite of preloading and in post-delivery period in both the groups. Pre eclamptic women showed higher SBP, DBP, MAP, CO & TPR compared to healthy pregnant women. DISCUSSION: There were significant changes in SV, CO, TPR that occurred under SAB in both normal and PIH parturients, more in PIH group. These diverse haemodynamic profiles analyzed in details by NICOM. The clinical effect of fluid challenge & vasopressors for treatment of hypotension is evident. CONCLUSIONS: NICOM is a promising monitoring system for parturients undergoing operative deliveries, allowing precise haemodynamic assessment & provide goal-directed therapy in women with preeclampsia.
