Cesarean Section

Baby  

Medical Need:

Cesearean section is currently the most commonly performed intervention worldwide.1 32% of all births in the US are delivered by cesearean section - mostly on maternal request.2

 

Hypotension in the course of spinal anesthesia remains a common side effect for cesarean delivery. The incidence of hypotension occurs in up to 95% of the cases.3,4 Studies have shown that there is a clear association of maternal hypotension with well-known unpleasant side-effects such as intraoperative and postoperative nausea and vomiting (IONV, PONV) with described incidences of up to 48% after induced spinal anesthesia for cesarean section.5,6,7 Hypotensive episodes, especially during cesarean delivery, is also known to have significant impact on fetal outcome, such as decreased uteroplacental blood flow, impaired fetal oxygenation or fetal acidosis.8

 

20130411 Hypotension and Side-effects NganKee EN

Source: Ngan Kee, W., et al. (2004)5

 

 

Solution:

The CNAP® technology enables a rapid response to changes of hemodynamics by combining all the advantages of noninvasiveness seen in upper arm NBP with the benefit of continuity as detected from invasive measurement.

 

 

Benefit:

The importance of continuous blood pressure monitoring during cesarean section is supported by a  comparison study of CNAP® versus NBP monitoring:

 

Ilies et. al. (2012) shows that in comparison with CNAP®  20% of all hypotensive episodes are missed by intermittent NBP during cesarean section.

 

20130415 CNAP vs NBP Ilies Var2 EN

Source: Ilies, C., et al. (2012)9

 

Further, it was shown that the pH value of the umbilical vein was significantly lower in hypotensive patients compared to normotensive mothers reflecting impaired homeostasis.

Thus, close-meshed hemodynamic management with CNAP® during cesearean section provides clear improvement of comfort and safety for mother and fetus.9

 

 

Devices designed for Cesarean Section:

 

 

 

See also:

 

References:

1 Driul, L., et al. Retrospective analysis of one year of cesarean sections: indications and risk factors associated with intrapartum cesarean section. Minerva Ginecol. 62(5):403-14 (2010).
2 The American College of Obstetricians and Gynecologists, Committee on Obstetrics Practice, Commitee Opinion. Number 559, April 2013.

3 Ngan Kee, W.D., et al. Prevention of maternal hypotension after regional anaesthesia for cesarean section. Current Opinion in Anaesthesiology. 23:304-309, doi:10.1097/ACO.0b013e328337ffc6 (2010).
4 Sharwood, G., et al. Hypotension in obstetric sinal anaesthesia: a lesson from pre-eclampsia. BJA. 102(3):291-4 (2009).

5 Ngan Kee, W.D., et al. Comparison of phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anaesthesia for Caesarean section. BJA. 92(4): 469-74, doi: 10.1093/bja/aeh088 (2004).

6 Balki, M., et al. Intraoperative nausea and vomiting during cesarean section under regional anesthesia. Int J Obstet Anesth. Jul;14(3):230-41 (2005).

7 Borgeat, A., et al. Postoperative Nausea and Vomiting in Regional Anesthesia. Anesthesiology. 98:530-47 (2003).

8 Lee, A., et al. A Quantitative, Systematic Review of Randomized Controlled Trials of Ephedrine Versus Phenylephrine for the Management of Hypotension During Spinal Anesthesia for Cesarean Delivery. Anesth Analg. 94:920-6 (2002).

9 Ilies, C., et al. Detection of hypotension during Caesarean section with continuous non-invasive arterial pressure device or intermittent oscillometric arterial pressure measurement. BJA. 109(3):413-9. doi: 10.1093/bja/aes224 (2012).