Haemodynamic differences among the inferior vena cava and uterine and placental arteries on the left lateral position during the third trimester of pregnancy with ultrasonography
Xue Qin1, Jing Zihan2, Guo Ran3, Jiang Meiqin4, Mei Jie4, Li Jia5, Wang Ling5
1Department of Ultrasound Diagnosis, Jiangyin Hospital Affiliated to the Medical College of South-East University, Jiangyin 214400, China; 2Department of the No1 Clinical Medicine, China Medical University, Shenyang 110122 China; 3Department of Anesthesia and Pain, Zhejiang Provincial People's Hospital, Hangzhou 310014 China; 4Department of Gynaecology and Obstetrics, Jiangyin Hospital Affiliated to the Medical College of South-East University, Jiangyin 214400, China; 5Department of Ultrasound Diagnosis, Zhongda Hospital Affiliated to the Medical College of South-East University, Nanjin 210009, China
Abstract：Objective To observe the haemodynamic differences among the inferior vena cava, uterine artery and umbilical artery on left lateral position in the third trimester of pregnancy with color Doppler ultrasonography (US).Methods Retrospective analysis was performed on the ultrasonographic manifestations of 73 cases of single-child full-term pregnancies that resulted in healthy deliveries in a Jiangyin Hospital Affiliated to the Medical College of Southeast University from January 2014 to October 2019. The pregnant women were 20-42 (29.34±5.16) years old and at 37-40.3 (39.1±1.0) weeks of gestation. They were examined with color Doppler US. (1) The internal diameter and maximum blood flow velocity of the inferior vena cava and haemodynamic parameters, including peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI), resistivity index (RI) and PSV/EDV (S/D) of the uterine and umbilical arteries in the supine position were compared with those in the 15° left lateral position. (2) The occurrence of supine hypotension syndrome(SHS) during ultrasound examination was observed, and the parameters of pregnant women with supine hypotension syndrome were compared with those without. These parameters included the internal diameter and maximum blood flow velocity of the inferior vena cava, the haemodynamic parameters of uterine and umbilical arteries, age, number of pregnancies, number of births, gestational age, body mass index (BMI) of the pregnant woman and foetal weight. (3) The diameter and maximum blood flow velocity of pregnant women with SHS of inferior vena cava were compared between the supine position and 15° left lateral position.Results (1) The median diameter of the inferior vena cava on the 15° left lateral position in 73 pregnant women was wider than that in the supine position(1.71[1.59, 1.85]cm vs. 1.37[1.22, 1.52]cm, Z=7.274, P＜0.05). The median maximum blood flow velocity on the 15° left lateral position was higher than that in the supine position (23.73[20.22, 28.59]cm/s vs. 21.80[19.95, 26.62]cm/s, Z=2.108, P＜0.05). No statistically significant differences in PSV, EDV, PI, RI and S/D of the uterine and umbilical arteries were observed between pregnant women on the supine position and those in the 15° left lateral position (all P values＞0.05). (2) Among the 73 cases, 24 (32.87%) had SHS, whereas 49 (67.13%) pregnant women had none. The internal diameter and maximum blood flow velocity of the inferior vena cava and the haemodynamic parameters of the uterine and umbilical arteries on the supine position were compared with those on the 15° left lateral position. The differences were not statistically significant (all P values＞0.05). Moreover, no significant differences in age, the number of pregnancies and the number of births were observed between the two groups (all P values＞0.05), and pregnant women with SHS had higher gestational weeks, BMIs and foetal weights (all P values＜0.05). (3) In the 24 pregnant women with SHS, the inner diameter and maximum blood flow velocity of the inferior vena cava on the 15° left lateral position were higher than those on the supine position (all P values<0.05).Conclusions SHS may occur during the ultrasound examination of full-term pregnant women, the degree of compression of the inferior vena cava can be reduced, and the symptoms disappear when pregnant women immediately change to the left lateral position. The haemodynamics of the uterine and foetal umbilical arteries did not change, that is, the hypotension of pregnant women did not affect uterine placenta blood perfusion. Moreover, pregnant weeks, BMI of the pregnant woman and foetal weight may be influential factors for SHS.
薛勤, 景孜涵, 郭然, 蒋美琴, 梅吉, 李嘉, 王玲. 超声检测足月妊娠孕妇左侧卧位时下腔静脉及子宫-胎盘血流的变化[J]. 中华解剖与临床杂志, 2021, 26(1): 28-33.
Xue Qin, Jing Zihan, Guo Ran, Jiang Meiqin, Mei Jie, Li Jia, Wang Ling. Haemodynamic differences among the inferior vena cava and uterine and placental arteries on the left lateral position during the third trimester of pregnancy with ultrasonography. Chinese Journal of Anatomy and Clinics, 2021, 26(1): 28-33.
封英, 陈新忠. 血管升压药防治剖宫产术蛛网膜下腔麻醉后低血压的研究进展[J]. 中华麻醉学杂志, 2019, 39(4): 397-400. DOI:10.3760/cma.j.issn.0254-1416.2019.04.004.Feng Y, Chen XZ. Progress in vasopressors-induced prevention of hypotension after spinal anaesthesia for caesarean section[J]. Chin J Anesthesiol, 2019, 39(4): 397-400. DOI:10.3760/cma.j.issn.0254-1416.2019.04.004.
[2]
郭敏, 雷波, 赵华巍, 等. 变换体位引起的下腔静脉直径改变对腰麻剖宫产仰卧位低血压综合征的预测作用[J]. 北京医学, 2019, 41(8): 683-686. DOI:10.15932/j.0253-9713.2019.08.017.Guo M, Lei B, Zhao HW, et al. Predictive effect of change of inferior vena cava diameter caused by postural changes on supine hypotension syndrome in caesarean section under subarachnoid anesthesia[J]. Beijing Medical Journal, 2019, 41(8): 683-686. DOI:10.15932/j.0253-9713.2019.08.017.
[3]
于晓芳. 体位护理干预对剖宫产术中仰卧位低血压综合征的影响[J]. 实用妇科内分泌电子杂志, 2018, 5(26): 5-6. DOI:10.3969/j.issn.2095-8803.2018.26.003.Yu XF. Effect of posture nursing intervention on supine hypotension syndrome during cesarean section[J]. Journal of Practical Gynecologic Endocrinology, 2018, 5(26): 5-6. DOI:10.3969/j.issn.2095-8803.2018.26.003.
[4]
苏应宽, 徐增祥, 江森. 实用产科学[M]. 济南: 山东科学技术出版社, 2004: 19.
[5]
Guo R, Xue Q, Qian Y, et al. The effects of ephedrine and phenylephrine on placental vascular resistance during cesarean section under epidual anesthesia[J]. Cell Biochem Biophys, 2015, 73(3): 687-693. DOI:10.1007/s12013-015-0676-7.
[6]
薛勤, 郭然, 邹大中, 等. 超声观察去氧肾上腺素防治剖宫产术低血压时对子宫-胎盘血流的影响[J]. 中国超声医学杂志, 2018, 34(1): 47-50. DOI:10.3969/j.issn. 1002-0101.2018.01.015.Xue Q, Guo R, Zou DZ, et al. Observations on effect of phenylephrine on uterine and placental haemodynamics following spinal anesthesia during cesarean section with ultrasonography[J]. Chinese J Ultrasound Med, 2018, 34(1): 47-50. DOI:10.3969/j.issn.1002-0101.2018.01.015.
[7]
张佐炳, 张晓东, 林锦蓉. 彩色多普勒超声检测子宫动脉及脐动脉在预测晚发型胎儿宫内生长受限中的价值[J]. 临床超声医学杂志, 2018, 20(8): 554-557. DOI:10.3969/j.issn.1008-6978.2018.08.016.Zhang ZB, Zhang XD, Lin JR. Value of color Dopple ultrasound in dectection of uterine and umbilical artery in prediction of late onset fetal growth restriction[J]. J Clin Ultrasound in Med, 2018, 20(8): 554-557. DOI:10.3969/j.issn.1008-6978.2018.08.016.
[8]
龚儒杰, 姚莉萍, 朱向明. 超声评估妊娠期高血压疾病孕妇左心功能改变及其与子宫动脉阻力指数的相关性[J]. 中国医学影像学杂志, 2019, 27(9): 709-713. DOI:10.3969/j.issn.1005-5185.2019.09.018.Gong RJ, Yao LP, Zhu XM. Assessment of changes in left heart function in pregant women with hypertensive disorder by ultrasound and correlations with resistance index of uterine helicine arteries[J]. Chinese Journal of Medical Imaging, 2019, 27(9): 709-713. DOI:10.3969/j.issn.1005-5185.2019.09.018.
[9]
庞静, 聂红艳, 陈伟伟, 等. 妊娠期高血压疾病产妇子宫动脉和胎儿脐动脉超声参数预测妊娠结局的临床价值[J]. 中国计划生育和妇产科, 2019, 11(1): 77-80. DOI:10.3969/j.issn.1674-4020.2019.01.21.Pang J, Nie HY, Chen WW, et al. The clinical value of ultrasonic parameters of uterine artery and fetal umbilical artery in predicting pregnancy outcome of women with hypertensive disorder complicating pregnancy[J]. Chinese Journal of Family Planning & Gynecotokology, 2019, 11(1): 77-80. DOI:10.3969/j.issn.1674-4020.2019.01.21.
[10]
El-Serougy L, Abdel Razek AA, Ezzat A, et al. Assessment of diffusion tensor imaging metrics in differentiating low-grade from high-grade gliomas[J]. Neuroradiol J, 2016, 29(5): 400-407. DOI:10.1177/1971400916665382.
[11]
Okwudire EG, Atalabi OM, Ezenwugo UM. The use of uterine artery doppler indices for prediction of pre-eclampsia in Port-Harcourt, Nigeria[J]. Niger Postgrad Med J, 2019, 26(4): 223-229. DOI:10.4103/npmj.npmj_54_19.
[12]
Ragaisyte E, Bardauskiene L, Zelbiene E, et al. Evaluation of volume status in a prehospital setting by ultrasonographic measurement of inferior vena cava and aorta diameters[J]. Turk J Emerg Med, 2018, 18(4): 152-157. DOI:10.1016/j.tjem.2018.07.002.
[13]
奚丰, 张晓庆, 唐晨程, 等. 产妇腰麻后仰卧位低血压综合征的危险因素[J]. 中华麻醉学杂志, 2016, 36(10): 1179-1181. DOI:10.3760/cma.j.issn.0254-1416.2016. 10.004.Xi F, Zhang XQ, Tang CC, et al. Risk factors for supine hypotension syndrome after spinal anesthesia in parturients[J]. Chin J Anesthesiol, 2016, 36(10): 1179-1181. DOI:10.3760/cma.j.issn.0254-1416.2016.10.004.
[14]
葛成霞, 郭建锋. 正常中晚孕胎盘弹性模量评价及影响因素初探[J]. 中国临床医学影像杂志, 2019, 30(10): 726-729. DOI:10.12117/jccmi.2019.10.010.Ge CX, Guo JF. Evaluation of the placental elastic modulus in the normal second or third trimester of pregnancy and its influencing factors[J]. J Chin Clin Med Imaging, 2019, 30(10): 726-729. DOI:10.12117/jccmi.2019.10.010.
[15]
Liao AW, Toyama J, Costa V, et al.Correlation between the Doppler velocimetry findings of the uterine arteries during the first and second trimesters of pregnancy[J]. Rew Assoc Med Bras(1992), 2009,55(2): 197-200. DOI:10.1590/s0104-42302009000200026.
2021, Vol. 26 
