Colloid co-load versus colloid pre-load in a parturient undergoing caesarean delivery with spinal anaesthesia and its effects on maternal haemodynamics

Background: cesarean section is the surgical delivery of a baby that involves making an incision in the mother's abdominal wall and uterus. Spinal anesthesia is considered the "gold standard" technique for cesarean section. Hypotension is the most common side effect of neuraxial blocks in the obstetric patient with an incidence rate reported as high as 83%. This has remained a significant concern for the anesthesiologist during management of this patient

Aim of the work: This study will be performed to compare the effects of colloid pre-load and colloid co-load on maternal haemodynamic changes during spinal anaesthesia for cesarean section

Patient's and Methods: A comparative cross sectional study was conducted at Ain Shams Maternity Hospital. After obtaining approval of research ethical committee and patients' informed consents at which 105 women with full term singleton pregnancies were scheduled for elective cesarean section and received spinal anesthesia. The patient's age were between 18 -42 years, of ASA physical status. In our study 3 groups of patients were compared; each group is formed of 35 patients Group 1; patients were pre-loaded with 500 ml of 6% HES[hydroxyethyl starch 130/0.4] 20 minutes before induction of anesthesia. Group2; patients were co-loaded with 500ml of 6% HES [hydroxyethyl starch 130/0.4] during injection of bupivacaine. Group 3; patients were pre-loaded with 500ml lactated ringer solution 20 minutes before induction of anaesthesia

Results: There was a decrease in SBP, DBP,MAP and HR in the 3 groups where the lowest values were recorded in group 3 between 6-15 minutes and there was a high statistical difference p<0.0001 while the intergroup comparison of the groups 1 and 2 showed no statistical significance as regards SBP,DBP,MAP and HR

Conclusion: In this study it was found that colloid co-load was somewhat how equal to colloid pre-load in prevention of hypotension in a parturient undergoing cesarean section under spinal anesthesia in addition it was found that crystalloid pre-load was inferior to colloid co-load or pre-load in maintaining blood pressure during spinal anesthesia in parturients

Assessment of the relation between fetal hemodynamic indices in late pregnancy and birth weight in gestational diabetic mellitus mothers: a correlational study

Background: The offspring of women with gestational diabetes mellitus [GDM] are prone to macrosomia. However, birth weight is difficult to be correctly estimated by ultrasound because of fetal asymmetric growth characteristics. This study aimed at investigating the correlations between fetal hemodynamics, fetal growth indices in late pregnancy and birth weight in GDM

Methods: A total of 180 women with GDM and 180 normal controls [NC] with singleton gestation and presented between 38-40 weeks gestation were enrolled in this study. Fetal hemodynamic indices, including the systolic/diastolic ratio [S/D], resistance index [RI], pulsatility index [PI] of umbilical artery [UA], middle cerebral artery [MCA], and renal artery [RA], were collected. Fetal growth indices, including biparietal diameter [BPD], head circumference [HC], abdominal circumference [AC], and femur length [FL], were also measured by ultrasound. Birth weight, mode of delivery and need for Neonatal ICU admission data were collected

Results: The independent samples t-test showed that BPD, HC, AC and FL were larger in GDM than in NC [P < 0.05]. Birth weight was higher in GDM than in NC [P < 0.001]. Among all included women, there was a highly statistically insignificant difference between GDM and NC groups as regard all ultrasound indices including UA_S/D, UA_RI, UA_PI, MCA_S/D, MCA_RI, MCA_PI, RA_S/D, RA_RI and RA_PI [P>0.05]. Pearson's correlation analysis showed in GDM group that there was a highly statistically significant negative correlation between birth weight and the following ultrasound indices: [UA_RI, UA_S/D, UA_PI, MCA_RI and MCA_PI] and that there was a statistically significant positive correlation between birth weight and RA_RI [P<0.01] [r = -0.273, -0.453, -0.537, -0.237, -0.265 and 0.169 respectively, P < 0.05], but As regard NC group there was a highly statistically significant negative correlation between birth weight and the following ultrasound indices: [UA_S/D, UA_RI, UA_PI and MCA_PI] [r = 0.148, -0.360, -0.252 and -0.184 respectively, P < 0.05] but no correlation was found with any of renal artery indices [P > 0.05]

Conclusions: Fetal hemodynamic indices in late pregnancy might be helpful for estimating newborn birth weight in women with GDM