Correlation of fetal hypoxia with intra-abdominal pressure during childbirth in patients with obesity


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Objective. To study the correlation of the parameters of the umbilical arterial blood acid-base status (ABS) and intra-abdominal pressure (IAP) during childbirth in patients with obesity. Subjects and methods. The investigators conducted a prospective randomized study involving 135 patients with spontaneous labor who were divided into 4 groups: 1) a control group of 38 persons; 2) 36 with first-degree obesity; 3) 40 with second-degree obesity; 4) 21 with third-degree obesity. IAP was investigated using the indirect transvesical method. The indicators of gas composition, ABS, and blood lactate concentration in the umbilical artery were studied. Results. The severity of fetal hypoxia was related to the level of IAP and the method of analgesia in labor. Correlation analysis of the relationship between the indicators of fetal hypoxia to the level of IAP showed that there was a strong correlation of pH, lactate, and IAP in labor pains (r=- 0.73 and 0.73; p<0.001). When epidural analgesia was used, the mean lactate values were significantly lower, but pH and pO2 were higher (p<0.05) than those in the subgroups, in which narcotic analgesics were administered. Conclusion. The level of IAP during childbirth affects the severity of fetal hypoxia. The high level of IAP in labor is the most likely reason for the high rate and severity of neonatal asphyxia in parturient women with obesity. In parturient women with high baseline IAP levels, epidural analgesia is the method of choice for pain relief in labor.

Full Text

Restricted Access

About the authors

Igor A. Salov

V.I. Razumovsky Saratov State Medical University

Email: Sarhospl@mail.ru
Doctor of Medical Sciences, Professor, Head of the department of Obstetrics and Gynecology

Dmitriy V. Marshalov

V.I. Razumovsky Saratov State Medical University

Email: MarshalD@mail.ru
Candidate of Medical Sciences, Lecturer at the Department of Obstetrics and Gynecology

Aleksej P. Petrenko

V.I. Razumovsky Saratov State Medical University

Email: Lesha.petrenko.66@mail.ru
Candidate of Medical Sciences, Lecturer at the Department of Emergency emergency and anesthesia-resuscitation

References

  1. Vernini J.M., Moreli J.B., Magalhães C.G., Costa R.A., Rudge M.V., Calderon I.M. Maternal and fetal outcomes in pregnancies complicated by overweight and obesity. Reprod. Health. 2016; 13(1): 100.
  2. Seneviratne S.N., Jiang Y., Derraik J., McCowan L., Parry G.K., Biggs J.B. et al. Effects of antenatal exercise in overweight and obese pregnant women on maternal and perinatal outcomes: a randomised controlled trial. BJOG. 2016; 123 (4): 588-97.
  3. Feresu S.A., Wang Y., Dickinson S. Relationship between maternal obesity and prenatal, metabolic syndrome, obstetrical and perinatal complications of pregnancy in Indiana, 2008-2010. BMC Pregnancy Childbirth. 2015; 15: 266.
  4. Crane J.M., Murphy P., Burrage L., Hutchens D. Maternal and perinatal outcomes of extreme obesity in pregnancy. J. Obstet. Gynaecol. Can. 2013; 35(7): 606-11.
  5. Sun L., Li W., Sun F., Geng Y., Tong Z., Li J. Intra-abdominal pressure in third trimester pregnancy complicated by acute pancreatitis: an observational study. BMC Pregnancy Childbirth. 2015; 15: 223.
  6. Sawchuck D.J., Wittmann B.K. Pre-eclampsia renamed and reframed: Intraabdominal hypertension in pregnancy. Med. Hypotheses. 2014; 83(5): 619-32.
  7. Curet M.J., Weber D.M., Sae A., Lopez J. Effects of helium pneumoperitoneum in pregnant ewes. Surg. Endosc. 2001; 15(7): 710-4.
  8. Karnak I., Aksoz E., Ekinci S., Onur R., Tanyel F.C. Increased maternal intraabdominal pressure alters the contractile properties of fetal rabbit bladder. J. Pediatr. Surg. 2008; 43(9): 1711-7.
  9. Marshalov D.V., Shifman E.M., Salov I.A., Petrenko A.P., Ioscovich A. Preeclampsia is a syndrome of intra-abdominal hypertension in pregnancy - would a hypothesis become a theory? J. Clin. Anesth. Manag. 2017; 2(1). http:// dx.doi. org/10.16966/2470-9956.122
  10. Sugerman H.J. Comment on: Correlations between intra-abdominal pressure and obesity-related co-morbidities. Surg. Obes. Relat. Dis. 2009; 5(5): 528-9.
  11. Malbrain M.L., De Keulenaer B.L., Oda J., De Laet I., De Waele J.J., Roberts D.J. et al. Intra-abdominal hypertension and abdominal compartment syndrome in burns, obesity, pregnancy, and general medicine. Anaesthesiol. Intensive Ther. 2015; 47(3): 228-40.
  12. Smit M., van Meurs M., Zijlstra J.G. Intra-abdominal pressure, acute kidney injury, and obesity in critical illness. Crit. Care Med. 2016; 44(8): 766-7.
  13. Todurov I.M., Bilians’ky L.S., Perekhristenko O.V., Kosiukhno S.V., Kalashnikov O.O., Plehutsa O.I. The factor of intra-abdominal pressure in patients with morbid obesity. Klin. Khir. 2013; (5): 28-31. (in Ukrainian)
  14. Marshalov D., Salov I., Shifman E., Petrenko A. Influence of epidural analgesia on abdominal wall pain tension and level of abdominal pressure in labor. Reg. Anesth. Pain Med. 2012; 37(7, Suppl.: Abstracts and Highlight Papers of the 31st Annual European Society of Regional Anaesthesia (ESRA) Congress 2012. September 5-8, Bordeaux, France): E278.
  15. Cheatham M.L. Intra-abdominal hypertension and abdominal compartment syndrome. New Horizon. 1999; 7: 96-115.
  16. Amiel-Tison C., Barrier G., Shnider S.M., Levinson G., Hughes S.C., Stefani S.J. A new neurologic and adaptive capacity scoring system for evaluating obstetric medications in full-term newborns. Anesthesiology. 1982; 56(5): 340-50.
  17. Li J., LaMarca B., Reckelhoff J.F. A model of preeclampsia in rats: the reduced uterine perfusion pressure (RUPP) model. Am. J. Physiol. Heart Circ. Physiol. 2012; 303(1): H1-8.
  18. Nasimi A. Hemodynamics. In: Gaze D., ed. The cardiovascular system - physiology, diagnostics and clinical implications. In Tech Europe; 2012: 95-108.
  19. Маршалов Д.В., Салов И.А., Петренко А.П., Шифман Е.М. Связь показателей центральной гемодинамики и внутрибрюшной гипертензии у беременных с ожирением. В. кн.: Материалы VII Регионального научного форума «Мать и дитя». Геленджик; 2014; 90-1.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies