Anticipation of Post Spinal supine Hypotension

in Cesarean section Patients Using USG-

PROSPECTIVE ANALYTICAL STUDY

Guide Dr. Biswajit Jena

Dr. Bishnu Prasad Mohapatra PGT
Associate Professor MKCGMCH
Dept of Anaesthesia MKCG MCH
 BACKGROUND
• Incidence of post spinal supine hypotension in
LSCS is approximately 70% .

•It can lead to adverse maternal and fetal

outcomes
Maternal - nausea, vomiting, dyspnea,
Fetal - depressed Apgar scores,
and fetal acidosis.
 INTRODUCTION
• Post-spinal hypotension during cesarean delivery is
caused by decreased systemic vascular resistance due to
the blockage of the autonomic nerves .(1)

• Worsened by inferior vena cava (IVC) compression by the

gravid uterus. (2)

• We intend to asses whether peak velocity and diameter of

IVC below xiphoid or RCFV in inguinal region as measured
on USG could reflect the degree of IVC compression and
identify parturients at risk of post spinal hypotension.(3)
 AIM
• To assess whether IVC and RCFV indices
interpreted using USG can be used to predict
post spinal supine hypotension in LSCS
patients after giving spinal.
 CRITERIA

Inclusion Criteria Exclusion Criteria

•Age 18–36 years,
• ASA score of III–IV
•ASA score of I–II
•Full-term (>37-week gestation) •Contraindications to spinal anesthesia
singelton pregnancy. •Pregnancy (> 42 weeks)
•A height of 140–160 cm.
•Maternal
PIH
Preeclampsia
Placenta previa
Placental abruption
Multiple pregnancy
Morbid obesity
•Fetal
Fetal distress
•Emergency cesarean delivery
 MATERIALS & METHODS
Institutional ethical committee approval.

Routine O and G OT MKCG MCH -GE Usg machine

56 parturients
Elective cesarean delivery
spinal anesthesia
January 2022 and June 2022

linear array probe (5–12 MHz) Phased Array probe(1- 5 MHz)

Transverse diameter and peak velocity of the

RCFV Anteroposterior diameter and peak
velocity of the IVC
Probe placed in Transverse position
at Groin crease. Xiphoid for IVC
1 cm proximal to the confluence of the great
saphenous vein into the common femoral
vein during end expiration.
 Statistical analysis

Patient and obstetric characteristics are presented as

Mean ± Standard deviation

Analyzed by

unpaired Student’s t-test Fisher’s exact probability test Pear- son’s Chi-Square test

IVC and RCFV Parameters

multinomial logistic regression analysis

SPSS for Windows, version 24.0

Statistical significance was set at P < 0.05

 Procedure
NPO for at least 6 hr

The Ultrasound measurements were performed in the PACU 1 h r before

transfering the patient to OT

IV line was established with an 18-G IV

catheter

Standard monitoring ECG,NIBP,SPO2

 Procedure

Hypotension Symptomatic Bradycardia

Phenylephrine bolus of 50 μg. Titrated dose of atropine

M-mode image showing the Pulsedwave Doppler showing
transverse diameter of RCFV the peak velocity of RCFV

M-mode image showing the Pulsedwave Doppler showing

diameter of IVC the peak velocity of IVC
 (Demographic Data)

Hypotension No hypotension P value

(n = 24) (n = 32)
Age (year) 24.5 ± 4.5 26.6 ± 4.1 0.986

Weight (kg) 64.2 ± 9.7 59.5 ± 7.3 0.050

Height (cm) 143.2 ± 5.9 143.4 ± 5.7 0.860

BMI 27.9 ± 3.5 26.1 ± 2.8 0.040

Gravity (n) 2(1–2.75) 1(1–2) 0.155

Parity (n) 0(0–0) 0(0–0) 0.571

Gestational age (weeks) 37.1 ± 1.1 37.7 ± 0.8 0.120

Baseline SBP (mmHg) 123 ± 12 121 ± 9 0.530

Baseline HR (bpm) 84 ± 12 83 ± 11 0.891

Neonatal body weight (g) 2812 ± 415 2516 ± 464 0.015

 Heart Rate
160

140

120

100
RCFV >12.2
Heart Rate

80 RCFV<=12.2

60

40

20

0
2 4 6 8 10 12 Time in Min
 MABP
140

120

100

80 RCFV >12.2
RCFV<=12.2
MABP

60

40

20

0
2 4 6 8 10 12 Time in Min
 Parameters of vessels probed by ultrasound between two groups

Hypotension No hypotension P value

(n = 24) (n = 32)

AP diameter of IVC (mm) 12.0 ± 2.2 11.5 ± 1.6 0.227

Peak velocity of IVC (cm/s) 33.6 ± 15.7 39.1 ± 16.3 0.094

Transverse diameter of 12.8 ± 1.7 11.2 ± 1.4 0.003

RCFV (mm)

Peak velocity of RCFV 8.2 ± 3.5 8.5 ± 4.9 0.810

(cm/s)
 CONCLUSION
• RCFV diameter of > 12.2 mm could predict parturients at
major risk of hypotension during cesarean section,
following anesthesia.

• The transverse diameter of the RCFV, measured by

ultrasound, may be an useful predictive method in routine
anesthesia practice for anticipation of intra op hypotension.

• IVC diameter and flow is not significant in prediction of Intra

op hypotension.
 References
1. Hofhuizen C, Lemson J, Snoeck M, Scheffer GJ. Spinal anesthesia-induced hypotension is caused
by a decrease in stroke volume in elderly patients. Local Reg Anesth. 2019 Mar 4;12:19-26. doi:
10.2147/LRA.S193925. PMID: 30881108; PMCID: PMC6404676.

2. Krywko DM, King KC. Aortocaval Compression Syndrome. [Updated 2022 Jul 1]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2022

3. Yao SF, Zhao YH, Zheng J, Qian JY, Zhang C, Xu Z, Xu T. The transverse diameter of right common
femoral vein by ultrasound in the supine position for predicting post-spinal hypotension during
cesarean delivery. BMC Anesthesiol. 2021 Jan 20;21

4. Yao SF, Zhao YH, Zheng J, Qian JY, Zhang C, Xu Z, Xu T. The transverse diameter of right common
femoral vein by ultrasound in the supine position for predicting post-spinal hypotension during
cesarean delivery. BMC Anesthesiol. 2021 Jan 20;21
THANK YOU