Pregnancy Related Clinical Trial
Official title:
Pulmonary Echography and BNP Value Pre- and Post- Elective Cesarean Section in Spinal Anesthesia
Pregnancy is characterized by many biohumoral changes: circulation, respiratory mechanics,
oncotic pressure, vascular permeability and many other systems are affected.
Vascular permeability is controlled by endothelial glycocalyx. Several factors such as
sepsis, ischemia / reperfusion, inflammatory mediators, trauma, surgery including the
Cesarean Section and fluid overload can increase vascular permeability due to a glycocalyx
damage.
During Cesarean Section under subarachnoid anesthesia, hypotension may occur. It is a common
side effect caused by reduced preload due to aortocaval compression by the uterus.
Furthermore, subarachnoid anesthesia causes block of the sympathetic preganglionic fibers
which is associated with vasodilation. These changes often require the use of vasopressors
and fluids.
A fluid overload associated with the physiological and pathological factors discussed earlier
might cause an increased risk of pulmonary edema and acute respiratory failure (IRA) in women
undergoing cesarean section under arachnoid anesthesia.
IRA occurs in less than 0.2% of total pregnancies but it is one of the most common cause of
admission to intensive care unit in pregnant women.
Among the causes that can lead to IRA in the last trimester of pregnancy we find
pneumopathies such as asthma, pulmonary embolism due to amniotic fluid and pulmonary edema
related to severe preeclampsia.
Diagnosis of pulmonary edema can be clinical or sub-clinical through laboratory tests such as
BNP (b-type natriuretic peptide). It might also be necessary to execute instrumental
examinations such as chest radiography (contraindicated in pregnancy) or trans-thoracic
ultrasound.
Hypothesis: correlation between subarachnoid anesthesia, fluidic therapy and BNP values and
ultrasound pattern
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