RESUMO
INTRODUCTION: Obese pregnant women are at risk of aortocaval compression and associated hypotension with neuraxial anaesthesia. We hypothesised that addition of reverse Trendelenburg tilt to the standard practice of pelvic tilt may attenuate aortocaval compression. METHODS: After ethical approval and consent, six women with a singleton pregnancy and booking body mass index of 30-35kg/m(2) underwent magnetic resonance imaging scanning in six different positions: right lateral decubitus; left lateral decubitus; supine with pelvic tilt; and reverse Trendelenburg positions of 5°, 10° and 15°. Dimensions of the inferior vena cava and abdominal aorta at the L2-3 intervertebral disc level were obtained from axial images using medical imaging software OsiriX™. RESULTS: Inferior vena cava dimensions were higher in left lateral decubitus position compared to supine with pelvic tilt (P=0.002). Inferior vena cava compression was noted in all participants (59±33%, 95% CI 32 to 86). Addition of 15° reverse Trendelenburg tilt to standard pelvic tilt produced a non-statistically significant increase in inferior vena cava area (10.54±9.91cm(2), 95% CI 2.61 to 18.47, P=0.06). CONCLUSION: A non-statistically significant improvement of aortocaval compression was noted with the addition of 15° reverse Trendelenburg tilt to the supine with pelvic tilt position in obese pregnant women.
Assuntos
Doenças da Aorta/fisiopatologia , Decúbito Inclinado com Rebaixamento da Cabeça , Obesidade/fisiopatologia , Posicionamento do Paciente , Complicações Cardiovasculares na Gravidez/fisiopatologia , Veia Cava Inferior/fisiopatologia , Adulto , Feminino , Humanos , GravidezRESUMO
Airway obstruction in pregnancy is rare. We report the case of a 39-year-old nulliparous woman with a body mass index of 47 kg/m(2) and a large multinodular goitre causing tracheal compression with airway symptoms who declined thyroid surgery until after delivery. However, worsening hypertension precipitated an urgent caesarean section and thyroidectomy at 32 weeks of gestation. As general anaesthesia was required, an awake fibreoptic intubation via the oral route was felt to be the safest option. Caesarean section was performed and a healthy baby delivered followed by a total thyroidectomy. She was extubated, monitored closely for tracheomalacia and cared for postoperatively in the surgical high-dependency unit. This case highlighted a number of challenges managed successfully with a multidisciplinary team.