Does Calcium Chloride Help Restore Maternal Blood Pressure and Uterine Blood Flow During Hemorrhagic Hypotension in Hypermagnesemic Gravid Ewes?

Background: The aim is to evaluate the effect of maternal transdermal nitro-glycerine patch administration on blood flow resistance on maternal uterine artery, fetal umbilical and middle cerebral arteries in patients with severe pre-eclampsia in early gestational age (24 weeks to 33 weeks) associated with abnormal Doppler indices (placental insufficiency) and also its effect on maternal mean arterial blood pressure.Methods: This is a prospective interventional clinical trial conducted on (50) pregnant women with singleton pregnancy diagnosed with severe pre-eclampsia admitted in high-risk pregnancy unit at the Department of Obstetrics in Tanta University Hospitals, A 50-mg transdermal GTN patch (Novartis Pharma) was applied to the abdominal skin, releasing nitroglycerin at a rate of 0.4 mg/h. Doppler ultrasonography and measurement of maternal blood pressure were performed before application of transdermal GTN patch, after 4 hours of application, after 24 hours and after 48 hours.Results: the application of a 50-mg transdermal GTN patch to the maternal abdomen was associated with a significant decline in the PI of the uteroplacental and fetoplacental blood flow. No change was observed in the PI of the cerebral circulation. And also, there was a significant decrease in maternal blood pressure (MAP).Conclusions: Nitroderm patch (nitric oxide donors) may be used as initial therapy in cases of severe preeclampsia complicated by placental insufficiency in the form of abnormal Doppler indices.

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Norepinephrine versus Ephedrine Boluses To Treat Spinal-Induced Hypotension in Cesarean Deliveries

QJM ◽

10.1093/qjmed/hcab086.062 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohamed M Abo Kamar ◽

Manal M Shams ◽

Mai M AbdelAziz ◽

Wessam Z Selima

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Spinal Anesthesia ◽

Cesarean Delivery ◽

Hypotensive Effect ◽

Maternal Blood ◽

Neurological Injury ◽

Maternal Complications ◽

Placental Blood ◽

Maternal Blood Pressure

Abstract Corresponding Background Cesarean sections normally require an anesthetic block at T4 level, so hypotension is reported to occur in up to 80% of spinal anesthesia cases. When maternal hypotension associated with spinal anesthesia for cesarean section is severe and sustained, it can lead to serious maternal complications as well as impairment of the uterine and placental blood flow with consecutive fetal hypoxia, acidosis, and neurological injury. Aim of the Work to compare the administration of intermittent i.v. boluses of norepinephrine and ephedrine to counterbalance the hypotensive effect of spinal anesthesia during cesarean delivery. The results of the study showed that compared with ephedrine, norepinephrine maintained maternal blood pressure and uterine artery blood flow. Further, it was associated with lower numbers of hypotension and hypertension episodes and less frequency of bradycardia and tachycardia during cesarean delivery. Furthermore, the numbers of boluses of vasopressors used during spinal anesthesia were lower in norepinephrine compared with the use of ephedrine. Conclusion Norepinephrine can be used as an alternative vasopressor to maintain maternal blood pressure during spinal anesthesia for cesarean delivery, with no adverse effect on neonatal outcome.

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The effect of isosorbide dinitrate on placental blood flow and maternal blood pressure in women with pregnancy induced hypertension

American Journal of Hypertension ◽

10.1016/s0895-7061(98)00249-0 ◽

1999 ◽

Vol 12 (4) ◽

pp. 341-347 ◽

Cited By ~ 24

Author(s):

I Thaler

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Isosorbide Dinitrate ◽

Maternal Blood ◽

Pregnancy Induced Hypertension ◽

Induced Hypertension ◽

Placental Blood ◽

Placental Blood Flow ◽

Maternal Blood Pressure

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Reliability of examining the external iliac artery with Doppler ultrasound in the first trimester and its relationship with maternal blood pressure and uterine artery blood flow

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2012.07.017 ◽

2012 ◽

Vol 165 (1) ◽

pp. 42-46 ◽

Cited By ~ 5

Author(s):

Walter Ventura ◽

Catalina De Paco ◽

Juan Luis Delgado ◽

José Eliseo Blanco ◽

Carolina Peñalver ◽

...

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Doppler Ultrasound ◽

Iliac Artery ◽

Uterine Artery ◽

External Iliac Artery ◽

First Trimester ◽

Maternal Blood ◽

Artery Blood Flow ◽

Maternal Blood Pressure

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Responses of fetal sheep to simulated no-decompression dives

Journal of Applied Physiology ◽

10.1152/jappl.1980.48.5.776 ◽

1980 ◽

Vol 48 (5) ◽

pp. 776-780 ◽

Cited By ~ 11

Author(s):

M. K. Stock ◽

E. H. Lanphier ◽

D. F. Anderson ◽

L. C. Anderson ◽

T. M. Phernetton ◽

...

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Maternal Blood ◽

Arterial System ◽

Fetal Sheep ◽

Monitoring Result ◽

Placental Blood ◽

Near Term ◽

Placental Blood Flow ◽

Maternal Blood Pressure

The effect of simulated standard no-decompression dives to 60 and 100 ft of seawater was tested in 12 near term sheep carrying 16 fetuses. In the immediate postdive period there were no significant changes in fetal blood pressure or fetal placental or renal blood flow, but the maternal blood pressure was elevated and the maternal placental blood flow was depressed. Six surgically prepared fetuses were dived to 100 ft. Five died within 20 min of ascent and the sixth suffered severe cardiac arrhythmia and hypotension. At autopsy all fetuses were observed to have massive bubbling in the arterial system and heart. Five fetuses were dived to 100 ft without surgery. Two were alive 3 h later and no bubbles were present at autopsy, and three were born alive at term. With the 60-ft dives, three fetuses were subjected to surgery and all suffered massive bubbling. Two fetuses were dived to 60 ft without surgery; one was alive after 3 h and the other was born alive at term. We conclude that surgery and monitoring result in the formation of postdive gas bubbles that would not otherwise appear.

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