The effect of fundal pressure at Caesarean section on maternal haemodynamics

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In 20 women undergoing Caesarean section, we determined brachial arterial blood pressure, heart rate and cardiac output (using an oesophageal Doppler probe) just after uterine incision and during the application of extra-abdominal uterine fundal pressure to facilitate delivery. Mean (SD) systolic aortic flow time (354.3 (35.4) ms), cardiac output (3.85 (0.68) l.min−1), heart rate (80.6 (14.2) beats.min−1) and blood pressure (84.7 (12.1) mmHg) decreased when fundal pressure was applied compared with after uterine incision (397.6 (31.6) ms, 4.69 (0.78) l.min−1, 95.1 (14.0) beats.min−1and 100.3 (12.0) mmHg, respectively; p < 0.05). Peak velocity and stroke distance of the aortic flow when fundal pressure was applied was similar to after uterine incision. The mothers and babies were not observed to be clinically compromised. The results suggest that applying fundal pressure to facilitate Caesarean delivery produces significant haemodynamic effects but the impact of these effects may be clinically insignificant.

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