BEST WAY TO POSITION WOMEN DURING CHILDBIRTH
New research is
challenging what many obstetricians and physician anesthesiologists believe is
the best way to position women during labor. According to a study published in
the February issue ofAnesthesiology, the official medical journal of the American Society of
Anesthesiologists (ASAthe traditional practice of positioning women on their
side, with hips tilted at 15 degrees, during labor does not effectively reduce
compression of the inferior vena cava, a large vein located near the abdominal
area that returns blood to the heart, as previously thought. In fact, not until
the degree of tilt reached 30 degrees did blood flow only partially increase in
patients, the study found.
It is widely believed
that lying women flat on their back during labor can lead to dangerously low
blood pressure caused by the compression of both the inferior vena cava and the
aorta due to the weight of the fetus," said Hideyuki Higuchi, M.D., study
author, department of anesthesiology, Tokyo Women's Medical University, Japan.
"It is accepted by many physicians that positioning women on their side,
with hips tilted at 15 degrees, during childbirth reduces this complication.
However, our research found no evidence of aortic compression in pregnant women
in any position and the recommended degree of tilt that most physicians follow
did not reduce compression of the inferior vena cava at all. This is the first
study to challenge this antiquated practice."
In the study, magnetic
resonance images (MRI) of 10 pregnant women at full term and 10 non-pregnant
women were obtained for measurement of the abdominal aorta, the largest artery
in the abdominal cavity, and the inferior vena cava. Measurements were taken while
the women laid flat on their back and while tilted at 15, 30, and 45 degrees.
Foam was placed under the right side of the study participants to achieve the
desired amount of tilt.
The study found that
abdominal aortic blood volume did not differ significantly between pregnant and
non-pregnant women regardless of the position in which they were placed.
Conversely, inferior vena cava blood volume was significantly lower in pregnant
women than in non-pregnant women when the women were positioned flat on their
back, indicating almost complete compression of the vein. Inferior vena cava
blood volume did not increase at 15 degrees, but partially increased at 30
degrees.
An accompanying
editorial commented favorably on the study's results, but offered a word of
caution:
"Although it
would be great to be able to conclude by saying all of our patients in the
delivery room should be placed in at least 30 degrees left lateral tilt after
regional anesthetic, I have serious doubts that our obstetric colleagues would
find it a reasonable position for cesarean delivery, particularly in obese
patients," said editorial author Craig Palmer, M.D., department of
anesthesiology, University of Arizona College of Medicine in Tucson, Ariz.
"There quite probably are patients for whom the modest (15 degree) tilt we
apply has a salutary effect. However, I will have to be less dogmatic about the
practice. Kudos to the authors of this study for revisiting an 'ancient'
practice, applying current technology to the matter, and shedding new light on
an old routine."
Comments
Post a Comment