Hemodynamic changes in women with symptoms of supine hypotensive syndrome
Introduction Supine positioning during late pregnancy causes the gravid uterus to compress the inferior vena cava, resulting in dramatic hemodynamic changes. The maintenance of placental perfusion requires maternal circulatory and autonomic adaptations. Women with supine hypotensive syndrome (define...
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| Veröffentlicht in: | Acta obstetricia et gynecologica Scandinavica 2020-05, Vol.99 (5), p.631-636 |
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| creator | Humphries, Aimee Mirjalili, Seyed A. Tarr, Gregory P. Thompson, John M. D. Stone, Peter |
| description | Introduction
Supine positioning during late pregnancy causes the gravid uterus to compress the inferior vena cava, resulting in dramatic hemodynamic changes. The maintenance of placental perfusion requires maternal circulatory and autonomic adaptations. Women with supine hypotensive syndrome (defined as a drop in systolic blood pressure of anything between 15 and 30 mmHg or an increase in heart rate of 20 bpm, with or without symptoms) may have reduced ability to compensate for the effects of supine positioning.
Material and methods
Twelve women with uncomplicated pregnancies and no symptoms of supine hypotension (normal) and 10 women with uncomplicated pregnancies who reported symptoms of supine hypotension between 34 and 38 weeks’ gestation underwent magnetic resonance imaging in the supine and left lateral positions. Phase contrast images were evaluated to measure blood flow through the aorta, inferior vena cava, superior vena cava and azygos vein.
Results
Women with symptoms of supine hypotension showed significant reductions in azygos venous flow rate compared with the normal group (−0.15 (−0.30 to −0.01) L/min). Those with symptoms showed no statistically significant compensatory changes in heart rate compared with the normal group (heart rate change 4.5 (−3.1 to 12.1) bpm). Hemodynamic changes in response to positioning were similar across both groups including: a reduction in inferior vena cava blood flow, reduction in cardiac output and an increase in azygos blood flow.
Conclusions
Maternal hemodynamic adaptations were found to be consistent across groups irrespective of whether the women had symptoms of supine hypotension. In both groups a reduction in blood flow through the inferior vena cava occurred in the supine position with a subsequent reduction in cardiac output. Both groups showed a compensatory increase in blood flow through the azygos vein in order to partially compensate for this. Taking into account the effect of maternal position, women with symptoms were found to have reduced azygos flow compared with asymptomatic women. There was a significant increase in heart rate when the women were supine than when they were in the left lateral position. |
| doi_str_mv | 10.1111/aogs.13789 |
| format | Article |
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Supine positioning during late pregnancy causes the gravid uterus to compress the inferior vena cava, resulting in dramatic hemodynamic changes. The maintenance of placental perfusion requires maternal circulatory and autonomic adaptations. Women with supine hypotensive syndrome (defined as a drop in systolic blood pressure of anything between 15 and 30 mmHg or an increase in heart rate of 20 bpm, with or without symptoms) may have reduced ability to compensate for the effects of supine positioning.
Material and methods
Twelve women with uncomplicated pregnancies and no symptoms of supine hypotension (normal) and 10 women with uncomplicated pregnancies who reported symptoms of supine hypotension between 34 and 38 weeks’ gestation underwent magnetic resonance imaging in the supine and left lateral positions. Phase contrast images were evaluated to measure blood flow through the aorta, inferior vena cava, superior vena cava and azygos vein.
Results
Women with symptoms of supine hypotension showed significant reductions in azygos venous flow rate compared with the normal group (−0.15 (−0.30 to −0.01) L/min). Those with symptoms showed no statistically significant compensatory changes in heart rate compared with the normal group (heart rate change 4.5 (−3.1 to 12.1) bpm). Hemodynamic changes in response to positioning were similar across both groups including: a reduction in inferior vena cava blood flow, reduction in cardiac output and an increase in azygos blood flow.
Conclusions
Maternal hemodynamic adaptations were found to be consistent across groups irrespective of whether the women had symptoms of supine hypotension. In both groups a reduction in blood flow through the inferior vena cava occurred in the supine position with a subsequent reduction in cardiac output. Both groups showed a compensatory increase in blood flow through the azygos vein in order to partially compensate for this. Taking into account the effect of maternal position, women with symptoms were found to have reduced azygos flow compared with asymptomatic women. There was a significant increase in heart rate when the women were supine than when they were in the left lateral position.</description><identifier>ISSN: 0001-6349</identifier><identifier>EISSN: 1600-0412</identifier><identifier>DOI: 10.1111/aogs.13789</identifier><identifier>PMID: 31856296</identifier><language>eng</language><publisher>HOBOKEN: Wiley</publisher><subject>aortocaval compression ; azygos vein ; collateral venous circulation ; Electrocardiography ; Heart rate ; Hemodynamics ; Life Sciences & Biomedicine ; maternal hemodynamics ; maternal sleep position ; Obstetrics & Gynecology ; Pregnancy ; Science & Technology ; supine hypotension ; third trimester ; Womens health</subject><ispartof>Acta obstetricia et gynecologica Scandinavica, 2020-05, Vol.99 (5), p.631-636</ispartof><rights>2019 Nordic Federation of Societies of Obstetrics and Gynecology</rights><rights>2019 Nordic Federation of Societies of Obstetrics and Gynecology.</rights><rights>Copyright © 2020 Acta Obstetricia et Gynecologica Scandinavica</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>25</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000505001600001</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c3939-8cec50154abad774113289dfc684f64b79fb93be998627021aabf4edc7b248773</citedby><cites>FETCH-LOGICAL-c3939-8cec50154abad774113289dfc684f64b79fb93be998627021aabf4edc7b248773</cites><orcidid>0000-0001-6944-381X ; 0000-0002-2154-1143 ; 0000-0003-0747-0964 ; 0000-0003-1546-752X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Faogs.13789$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Faogs.13789$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,782,786,1419,27931,27932,28255,45581,45582</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31856296$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Humphries, Aimee</creatorcontrib><creatorcontrib>Mirjalili, Seyed A.</creatorcontrib><creatorcontrib>Tarr, Gregory P.</creatorcontrib><creatorcontrib>Thompson, John M. D.</creatorcontrib><creatorcontrib>Stone, Peter</creatorcontrib><title>Hemodynamic changes in women with symptoms of supine hypotensive syndrome</title><title>Acta obstetricia et gynecologica Scandinavica</title><addtitle>ACTA OBSTET GYN SCAN</addtitle><addtitle>Acta Obstet Gynecol Scand</addtitle><description>Introduction
Supine positioning during late pregnancy causes the gravid uterus to compress the inferior vena cava, resulting in dramatic hemodynamic changes. The maintenance of placental perfusion requires maternal circulatory and autonomic adaptations. Women with supine hypotensive syndrome (defined as a drop in systolic blood pressure of anything between 15 and 30 mmHg or an increase in heart rate of 20 bpm, with or without symptoms) may have reduced ability to compensate for the effects of supine positioning.
Material and methods
Twelve women with uncomplicated pregnancies and no symptoms of supine hypotension (normal) and 10 women with uncomplicated pregnancies who reported symptoms of supine hypotension between 34 and 38 weeks’ gestation underwent magnetic resonance imaging in the supine and left lateral positions. Phase contrast images were evaluated to measure blood flow through the aorta, inferior vena cava, superior vena cava and azygos vein.
Results
Women with symptoms of supine hypotension showed significant reductions in azygos venous flow rate compared with the normal group (−0.15 (−0.30 to −0.01) L/min). Those with symptoms showed no statistically significant compensatory changes in heart rate compared with the normal group (heart rate change 4.5 (−3.1 to 12.1) bpm). Hemodynamic changes in response to positioning were similar across both groups including: a reduction in inferior vena cava blood flow, reduction in cardiac output and an increase in azygos blood flow.
Conclusions
Maternal hemodynamic adaptations were found to be consistent across groups irrespective of whether the women had symptoms of supine hypotension. In both groups a reduction in blood flow through the inferior vena cava occurred in the supine position with a subsequent reduction in cardiac output. Both groups showed a compensatory increase in blood flow through the azygos vein in order to partially compensate for this. Taking into account the effect of maternal position, women with symptoms were found to have reduced azygos flow compared with asymptomatic women. There was a significant increase in heart rate when the women were supine than when they were in the left lateral position.</description><subject>aortocaval compression</subject><subject>azygos vein</subject><subject>collateral venous circulation</subject><subject>Electrocardiography</subject><subject>Heart rate</subject><subject>Hemodynamics</subject><subject>Life Sciences & Biomedicine</subject><subject>maternal hemodynamics</subject><subject>maternal sleep position</subject><subject>Obstetrics & Gynecology</subject><subject>Pregnancy</subject><subject>Science & Technology</subject><subject>supine hypotension</subject><subject>third trimester</subject><subject>Womens health</subject><issn>0001-6349</issn><issn>1600-0412</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><recordid>eNqNkU1P3DAQhq0KVLbQS39AFYlLVRTwV2L7iFZ8SUgcaM-R40xYo42dxgko_76z7MKBA8KWZmT5mVev3iHkB6OnDM-ZjQ_plAmlzReyYCWlOZWM75EFpZTlpZDmgHxL6RFfXEn9lRwIpouSm3JBbq6hi80cbOdd5lY2PEDKfMieYwdY_bjK0tz1Y-xSFtssTb0PkK3mPo4Qkn8C_A7NgPQR2W_tOsH3XT8kfy8v_iyv89u7q5vl-W3uhBEm1w5cQVkhbW0bpSRjgmvTtK7Usi1lrUxbG1GDMbrkinJmbd1KaJyqudRKiUPya6vbD_HfBGmsOp8crNc2QJxSxQU3SqCoRvT4HfoYpyGgO6QM1wUKcqR-byk3xJQGaKt-8J0d5orRahNwtQm4egkY4Z87yanuoHlDXxNFQG-BZ6hjm5yH4OANw40UeOlmS1iXfrSjj2EZpzDi6MnnR5FmO9qvYf7Ac3V-d3W_df8fs1qmGQ</recordid><startdate>202005</startdate><enddate>202005</enddate><creator>Humphries, Aimee</creator><creator>Mirjalili, Seyed A.</creator><creator>Tarr, Gregory P.</creator><creator>Thompson, John M. D.</creator><creator>Stone, Peter</creator><general>Wiley</general><general>John Wiley & Sons, Inc</general><scope>AOWDO</scope><scope>BLEPL</scope><scope>DTL</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6944-381X</orcidid><orcidid>https://orcid.org/0000-0002-2154-1143</orcidid><orcidid>https://orcid.org/0000-0003-0747-0964</orcidid><orcidid>https://orcid.org/0000-0003-1546-752X</orcidid></search><sort><creationdate>202005</creationdate><title>Hemodynamic changes in women with symptoms of supine hypotensive syndrome</title><author>Humphries, Aimee ; Mirjalili, Seyed A. ; Tarr, Gregory P. ; Thompson, John M. D. ; Stone, Peter</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3939-8cec50154abad774113289dfc684f64b79fb93be998627021aabf4edc7b248773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>aortocaval compression</topic><topic>azygos vein</topic><topic>collateral venous circulation</topic><topic>Electrocardiography</topic><topic>Heart rate</topic><topic>Hemodynamics</topic><topic>Life Sciences & Biomedicine</topic><topic>maternal hemodynamics</topic><topic>maternal sleep position</topic><topic>Obstetrics & Gynecology</topic><topic>Pregnancy</topic><topic>Science & Technology</topic><topic>supine hypotension</topic><topic>third trimester</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Humphries, Aimee</creatorcontrib><creatorcontrib>Mirjalili, Seyed A.</creatorcontrib><creatorcontrib>Tarr, Gregory P.</creatorcontrib><creatorcontrib>Thompson, John M. D.</creatorcontrib><creatorcontrib>Stone, Peter</creatorcontrib><collection>Web of Science - Science Citation Index Expanded - 2020</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Acta obstetricia et gynecologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Humphries, Aimee</au><au>Mirjalili, Seyed A.</au><au>Tarr, Gregory P.</au><au>Thompson, John M. D.</au><au>Stone, Peter</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hemodynamic changes in women with symptoms of supine hypotensive syndrome</atitle><jtitle>Acta obstetricia et gynecologica Scandinavica</jtitle><stitle>ACTA OBSTET GYN SCAN</stitle><addtitle>Acta Obstet Gynecol Scand</addtitle><date>2020-05</date><risdate>2020</risdate><volume>99</volume><issue>5</issue><spage>631</spage><epage>636</epage><pages>631-636</pages><issn>0001-6349</issn><eissn>1600-0412</eissn><abstract>Introduction
Supine positioning during late pregnancy causes the gravid uterus to compress the inferior vena cava, resulting in dramatic hemodynamic changes. The maintenance of placental perfusion requires maternal circulatory and autonomic adaptations. Women with supine hypotensive syndrome (defined as a drop in systolic blood pressure of anything between 15 and 30 mmHg or an increase in heart rate of 20 bpm, with or without symptoms) may have reduced ability to compensate for the effects of supine positioning.
Material and methods
Twelve women with uncomplicated pregnancies and no symptoms of supine hypotension (normal) and 10 women with uncomplicated pregnancies who reported symptoms of supine hypotension between 34 and 38 weeks’ gestation underwent magnetic resonance imaging in the supine and left lateral positions. Phase contrast images were evaluated to measure blood flow through the aorta, inferior vena cava, superior vena cava and azygos vein.
Results
Women with symptoms of supine hypotension showed significant reductions in azygos venous flow rate compared with the normal group (−0.15 (−0.30 to −0.01) L/min). Those with symptoms showed no statistically significant compensatory changes in heart rate compared with the normal group (heart rate change 4.5 (−3.1 to 12.1) bpm). Hemodynamic changes in response to positioning were similar across both groups including: a reduction in inferior vena cava blood flow, reduction in cardiac output and an increase in azygos blood flow.
Conclusions
Maternal hemodynamic adaptations were found to be consistent across groups irrespective of whether the women had symptoms of supine hypotension. In both groups a reduction in blood flow through the inferior vena cava occurred in the supine position with a subsequent reduction in cardiac output. Both groups showed a compensatory increase in blood flow through the azygos vein in order to partially compensate for this. Taking into account the effect of maternal position, women with symptoms were found to have reduced azygos flow compared with asymptomatic women. There was a significant increase in heart rate when the women were supine than when they were in the left lateral position.</abstract><cop>HOBOKEN</cop><pub>Wiley</pub><pmid>31856296</pmid><doi>10.1111/aogs.13789</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0001-6944-381X</orcidid><orcidid>https://orcid.org/0000-0002-2154-1143</orcidid><orcidid>https://orcid.org/0000-0003-0747-0964</orcidid><orcidid>https://orcid.org/0000-0003-1546-752X</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | aortocaval compression azygos vein collateral venous circulation Electrocardiography Heart rate Hemodynamics Life Sciences & Biomedicine maternal hemodynamics maternal sleep position Obstetrics & Gynecology Pregnancy Science & Technology supine hypotension third trimester Womens health |
| title | Hemodynamic changes in women with symptoms of supine hypotensive syndrome |
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