Pulmonary Echography and BNP Value Pre- and Post- Elective Cesarean Section in Spinal Anesthesia
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|ClinicalTrials.gov Identifier: NCT03851679|
Recruitment Status : Completed
First Posted : February 22, 2019
Last Update Posted : February 22, 2019
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
|Condition or disease||Intervention/treatment|
|Pregnancy Related||Diagnostic Test: B-Type natriuretic peptide (BNP) serum values Device: Pulmonary echography Other: urine collection|
|Study Type :||Observational|
|Actual Enrollment :||80 participants|
|Official Title:||Pulmonary Echography and BNP Value Pre- and Post- Elective Cesarean Section in Spinal Anesthesia|
|Actual Study Start Date :||December 17, 2016|
|Actual Primary Completion Date :||August 8, 2018|
|Actual Study Completion Date :||November 2018|
woman who are submitted to elective Cesarean Section in spinal anesthesia
Diagnostic Test: B-Type natriuretic peptide (BNP) serum values
evaluation BNP serum values:
Device: Pulmonary echography
Other: urine collection
6 hour and 24 hour urine collection after Cesarean Section
- Ultrasound pulmonary variations [ Time Frame: pulmonary echography is made 30 minutes before Cesarean Section, 6 and 24 hours after surgery ]The main goal of our study is to evaluate, preoperatively, the incidence of ultrasound pulmonary variations in pregnant women attending elective Cesarean Section
- subclinical pulmonary echography variation [ Time Frame: pulmonary echography is made 30 minutes before Cesarean Section, 6 and 24 hours after surgery ]Evaluating the incidence of subclinical variations in ecographic lung characteristics at 6 and 24 hours after Cesarean Section
- B-type natriuretic peptide serum value variation [ Time Frame: B-type natriuretic peptide serum level is sampled 30 minutes before Cesarean Section, 6 and 24 hours after surgery 30 minutes before Cesarean Section, 6 and 24 hours after surgery ]Finding if there is any correlation between preoperative b-type natriuretic peptide and ecographic lung characteristics in pregnants, before and 24 hours after Cesarean Section
- fluid administration and pulmonary echography variation [ Time Frame: pulmonary echography is made 30 minutes before Cesarean Section, 6 and 24 hours after surgery ]Finding if there is any correlation between intraoperative fluids administered and ecographic lung characteristics