Changes in sonographically measured inferior vena caval diameter in response to fluid loaDing in term pregnancy

Celso A. Hernandez, Kathryn L. Reed, Elizabeth B. Juneman, Wayne R. Cohen

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives-The purpose of this study was to determine whether the inferior vena caval (IVC) diameter is influenced by intravascular volume changes in pregnancy. Methods-A prospective observational study was done on 2 groups of normal term gravidas. In 24 patients, we measured the IVC diameter, blood pressure, and heart rate (HR) before and after a 1-L fluid infusion in preparation for regional anesthesia, after initiation of an epidural block, and within 24 hours postpartum. In a second group of 15 women, we measured the IVC diameter sequentially during a 1-L crystalloid infusion. Results-In the first group, the mean baseline IVC diameter ± SD at end-inspiration was 1.45 ± 0.32 cm, which was 19% smaller than at end-expiration (1.73 ± 0.31 cm; P= .003). This respiratory cycle variation remained significant at each measurement epoch. The mean caval diameter at end-inspiration increased by 23% after the fluid bolus (P = .012). Hydration was not, however, accompanied by any significant change in the HR, mean arterial pressure, or collapsibility index of the inferior vena cava. With epidural anesthesia, the mean arterial pressure decreased from 88 ± 9 to 80 ± 7 mm Hg (P= .018), but the HR and collapsibility index remained unchanged. Postpartum values were not significantly different from their baseline measurements, except for the mean arterial pressure, which was lower by about 6 mm Hg (P = .042). In the second group, the IVC diameter at end-inspiration increased by 31% after the 1-L infusion, and there was a positive correlation between the volume infused and the IVC diameter (r = 0.67; P<.0001). Conclusions-Measurable variations in the IVC diameter occur in response to volume changes in normal term pregnancy and postpartum.

Original languageEnglish (US)
Pages (from-to)389-394
Number of pages6
JournalJournal of Ultrasound in Medicine
Volume35
Issue number2
DOIs
StatePublished - Feb 1 2016

Fingerprint

Venae Cavae
Pregnancy
Postpartum Period
Arterial Pressure
Heart Rate
Conduction Anesthesia
Epidural Anesthesia
Inferior Vena Cava
Observational Studies
Prospective Studies
Blood Pressure

Keywords

  • Collapsibility index
  • Inferior vena cava diameter
  • Obstetric ultrasound
  • Pregnancy
  • Volume status

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Changes in sonographically measured inferior vena caval diameter in response to fluid loaDing in term pregnancy. / Hernandez, Celso A.; Reed, Kathryn L.; Juneman, Elizabeth B.; Cohen, Wayne R.

In: Journal of Ultrasound in Medicine, Vol. 35, No. 2, 01.02.2016, p. 389-394.

Research output: Contribution to journalArticle

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abstract = "Objectives-The purpose of this study was to determine whether the inferior vena caval (IVC) diameter is influenced by intravascular volume changes in pregnancy. Methods-A prospective observational study was done on 2 groups of normal term gravidas. In 24 patients, we measured the IVC diameter, blood pressure, and heart rate (HR) before and after a 1-L fluid infusion in preparation for regional anesthesia, after initiation of an epidural block, and within 24 hours postpartum. In a second group of 15 women, we measured the IVC diameter sequentially during a 1-L crystalloid infusion. Results-In the first group, the mean baseline IVC diameter ± SD at end-inspiration was 1.45 ± 0.32 cm, which was 19{\%} smaller than at end-expiration (1.73 ± 0.31 cm; P= .003). This respiratory cycle variation remained significant at each measurement epoch. The mean caval diameter at end-inspiration increased by 23{\%} after the fluid bolus (P = .012). Hydration was not, however, accompanied by any significant change in the HR, mean arterial pressure, or collapsibility index of the inferior vena cava. With epidural anesthesia, the mean arterial pressure decreased from 88 ± 9 to 80 ± 7 mm Hg (P= .018), but the HR and collapsibility index remained unchanged. Postpartum values were not significantly different from their baseline measurements, except for the mean arterial pressure, which was lower by about 6 mm Hg (P = .042). In the second group, the IVC diameter at end-inspiration increased by 31{\%} after the 1-L infusion, and there was a positive correlation between the volume infused and the IVC diameter (r = 0.67; P<.0001). Conclusions-Measurable variations in the IVC diameter occur in response to volume changes in normal term pregnancy and postpartum.",
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