This syndrome manifests in three main forms on the basis of the tissues involved. Supine positioning of a pregnant patient will result in aortocaval compression acc. Aortocaval compression acc occurs when the gravid uterus compresses the maternal abdominal aorta and inferior vena cava ivc. The negative consequences of acc were first brought to light over 70 years ago, and much of clinical practice today is based on studies that are now decades old. It has been further demonstrated that the supine position can result in greater aortocaval compression than other positions such as left lateral decubitus, right lateral decubitus and upright positions 11, 14. Aortocaval compression syndrome supine hypotensive syndrome represents a common complication mainly of late pregnancy, although the syndrome has been described to occur as early as 16 weeks of. Endovascular repair is a valid alternative for patients with abdominal aortic aneurysms. We have compared measures of heart rate variability hrv in 15 women in late pregnancy before and 3 months after delivery and in 20 nonpregnant controls, to study the effect of aortocaval compression on autonomic nervous activity. Indeed, performing pelvic tilt in mothers at term to avoid aortocaval compression is a universally adopted measure, particularly during cesarean delivery. The description of the supinehypotension syndrome goes back at least as far as 1953 when howard et al. This pathophysiologic state occurs in a pregnant female, typically after 20 weeks gestation, when the patient is placed in the percent position. Complications expected after ivc ligation include leg edema 30%, recurrent dvt 16%, venous pelvic compression syndrome, and venous claudication, although it is well tolerated in most cases.
To alleviate the consequent aortocaval compression, gravity is often used to laterally displace the uterus. Since these diseases may give rise to many, seemingly unrelated symptoms in addition to pain, they are explained here for a broader audience. Aortocaval compression can cause hemodynamic disturbances and uteroplacental hypoperfusion in parturients. Compression of the ivc impedes venous return which decreases cardiac output co, and compression of the aorta may reduce uteroplacental perfusion which may result in fetal acidosis. However, up to 15% of women at term can demonstrate supine hypotensive syndrome of pregnancy, defined as a decrease in systolic blood pressure of at least 1530 mmhg. Get a printable copy pdf file of the complete article 372k, or click on a page image below to browse page by page. Supine hypotensive syndrome of pregnancy anesthesiology core.
This aortocaval compression reduces maternal cardiac output, an event that is often concealed, because only 10% of pregnant women will exhibit supine hypotension syndrome. Aortocaval compression acc can result in haemodynamic disturbances and. The syndrome has been demonstrated in pregnant females from the middle of the second trimester onward. Patients with severe ivc compression could only be identified using serial co measurements when their co was found to be significantly higher when ivc compression was relieved at. It could make you more likely to have a dvt deep vein. Aortocaval compression in the sitting and lateral decubitus positions during extradural catheter placement in the parturient. Oxford university press is a department of the university of oxford. It could make you more likely to have a dvt deep vein thrombosis in your left leg. In innominate artery compression syndrome, the aortic arch and ligamentum are in their normal leftward position. Recent evidence is beginning to refine our understanding of the physiologic consequences of aortocaval compression in the. Dizziness and a drop in blood pressure caused when the mother is in a supine position and the weight of the uterus, infant, placenta, and amniotic fluids compress the inferior vena cava, reducing return of blood to the heart and cardiac output. Avoidance of the supine position in late pregnancy, to prevent aortocaval compression acc by the gravid uterus, is a fundamental principle in the management.
Compression of the vena cava is a real occurrence when assuming the supine position. Supine hypotensive syndrome of pregnancy anesthesiology. Diagnosis and treatment of vascular compression syndromes. The combination of aortal and venal compression which occurs in the supine position is called aortocaval compression. The nature and severity of symptoms range from unspecific complaints to severe maternal hypotension. Your blood vessels carry blood to every part of your body.
All abdominal vascular compression syndromes are caused by the discrepancy between the anatomy of man, which corresponds in principle to a quadruped. The studies on which this practice is based are largely nonrandomized, utilized a mix of anesthetic techniques, and were conducted decades ago in the setting of avoidance of vasopressors. Nevertheless, aortocaval compression can reduce cardiac output and impair placental blood flow, so it remains rational to use tilt during anaesthesia, although the exact contribution of tilt to reducing hypotension in spinal anaesthesia is unclear. This page was last edited on 8 october 2019, at 08. Maternal cardiac arrest during cesarean section cs is an extremely rare but devastating complication. Supine lying during pregnancy pelvic, obstetric and. The clinical presentation is often obscure, depending on the coexistence of retroperitoneal rupture and hemodynamic instability. Aortocaval compression syndrome definition of aortocaval. Lee, md, and ruth landau, md from the department of anesthesiology, columbia university, new york, new york. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Celiac ganglion compression syndrome celiac trunk compression syndrome, celiac artery compression. Pdf file of the complete article 372k, or click on a page image below to browse page by page. Full text is available as a scanned copy of the original print version.
Thoracic outlet syndrome tos describes a broad spectrum of symptoms and signs all related to compression or injury of the key anatomical structures that traverse this narrow aperture on their way to the upper extremity. Conservative management of persistent aortocaval fistula. Truefalse supine hypotension is compensated by an increase in peripheral sympathetic activity. The objective of this study was to explore the correlation between obesity and an elevated pressure in the vci simulating obesity. Aortocaval compression syndrome statpearls ncbi bookshelf. Obstetric anaesthesia and analgesia inc neonatal annelise kerr 3ph.
Forty asa i or ii parturients, at term and in active labour, who requested extradural analgesia were randomly allocated to one of two groups. Symptoms include dizziness, nausea, paleness or flushing, and a sense of claustrophobia when lying on the back. Severe acute respiratory distress syndrome in pregnancy. Nonobstetric surgery during pregnancy journal of obstetric. Diagnosis and treatment of vascular compression syndromes of the abdomen based on the. Thus, aortocaval compression is a rule in late pregnancy in the supine position.
Jun 29, 2019 aortocaval compression syndrome is compression of the abdominal aorta and inferior vena cava by the gravid uterus when a pregnant woman lies on her back. Files are available under licenses specified on their description page. Haemodynamic effects from aortocaval compression at. Tilting at aortocaval compression anesthesiology asa publications. Aortocaval compression in the sitting and lateral decubitus. Aortocaval compression resulting in sudden loss of consciousness. Avoidance of the supine position in late pregnancy, to prevent aortocaval compression acc by the gravid uterus, is a fundamental principle in the management of pregnant women, particularly during labor or at cesarean delivery. Aortocaval compression syndrome is compression of the abdominal aorta and inferior vena. Aortocaval compression syndrome is compression of the abdominal aorta and inferior vena cava by the gravid uterus when a pregnant woman lies on her back. Vena cava compression syndrome in patients with obesity. Haemodynamic effects from aortocaval compression at different angles of lateral tilt in nonlabouring term pregnant. However, in patients with concomitant aortocaval fistulas, type ii endoleaks may result in a persistent communication between the aneurysm sac and the inferior vena cava. Reeves opinions generally have a liberal benthe opposed the war to topple saddam hussein as stupid and unnecessary column, rexentor 19, but shuns extreme leftist positions.
Aortocaval fistula acf is an unusual complication of ruptured abdominal aortic aneurysm aaa, involving less than 36% of all ruptured cases. It is a frequent cause of low maternal blood pressure hypotension, which can result in loss of consciousness and in extreme circumstances fetal demise. The overall mortality rate of aortocaval fistula is about 21%. Relief of this compression most likely does not occur until the patient is turned 30, which is not feasible for performing cesarean delivery.
Studies have shown radiographic and physiologic improvement in aortocaval compression in the lateral compared to supine position. If you drew a line between the part where your rib cage splits into two, and the belly button, and. Cardiac output can decrease by 30%40% in patients with this syndrome. This compression may decrease cardiac output and cause supine hypotensive syndrome. Truefalse the blood pressure measured in the arms, is a reliable predictor of. Tilting at aortocaval compression anesthesiology asa. This pathophysiologic state occurs in a pregnant female. Parturients in the first group n 22 were positioned in the left lateral decubitus position and those in. Because the leftlateral position is impractical in clinical situations, a leftlateral tilt position is often promoted to reduce aortocaval compression by the pregnant uterus. Editorial aortocaval compression syndrome international. The prevalence and implications of aortocaval compression have been firmly established. To make squares disappear and save space for other squares you have to assemble english words left, right, up, down from the falling squares.
We present a patient with an abdominal aortic aneurysm. Pdf tilting at aortocaval compression researchgate. Return of autonomic nervous activity after delivery. Case report inferior vena cava thrombosis, aortocaval. Aortocaval compression syndrome is compression of the abdominal aorta and inferior vena cava by the gravid uterus when a pregnant woman lies on her back, i.
With aortal compression, uterine artery pressure and uterine blood flow are decreased. Comparison of supine and upright positions on autonomic. Since then, avoidance of the supine position has become a key component of clinical practice. Artery compression an overview sciencedirect topics. Indeed, performing pelvic tilt in mothers at term to avoid aortocaval comp. Diagnosis and treatment of vascular compression syndromes of. Aortocaval compression syndrome supine hypotensive syndrome represents a common complication mainly of late pregnancy, although the syndrome has been described to occur as early as 16 weeks of gestation. The association between arterial hypotension and the supine position in late pregnant women was first. Although some pregnant women will naturally avoid lying supine, they are often put into this position during their medical care.
We prospectively studied the incidence of concealed aortocaval compression in parturients at term during identification of the extradural space. Effect of lateral tilt angle on the volume of the abdominal. Aortocaval compression syndrome is also known as a supine hypotensive syndrome. A few reports have been published over the past years regarding successful endovascular treatment of aortocaval fistulation.
Maythurner syndrome, also known as iliac vein compression syndrome or cocketts syndrome, affects two blood vessels that go to your legs. More than 70 years ago, the phenomenon of postural shock in the supine position was described in healthy women in late pregnancy. The first page of the pdf of this article appears above. Previous studies have shown that in late pregnancy a compression of the inferior vena cava vci leads to a hypotensive syndrome. All structured data from the file and property namespaces is available under the creative commons cc0 license. The aorticaval region is the space where the abdominal aorta biggest artery in the abdomen and the inferior vena cava main vein in the abdomen. A brief summary of aortocaval compression, an important topic in obstetric anesthesia.
The symptoms of innominate artery compression may be mild to severe. Lettris is a curious tetrisclone game where all the bricks have the same square shape but different content. We considered the use of a kinetic turning bed, but felt that patient rotation would be contraindicated because of the risk of intermittent aortocaval compression. Haemodynamic effects from aortocaval compression at different. Our patient was placed supine in a lefttilt position after epidural anesthesia. Symptoms include dizziness, nausea, paleness or flushing, and. As the artery courses from left to right anterior to the trachea, it causes tracheal compression. In these patients, prompt closure of the persistent fistula has been advocated. Aortocaval compression one minute anesthesia on vimeo. Links to pubmed are also available for selected references. Thank you for your interest in spreading the word about the bmj. Supine hypotensive syndrome may become a lifethreatening condition, especially for patients with sas, as demonstrated in our case.
Aortocaval compression resulting in sudden loss of. Clinical manifestations of aortocaval fistulas in ruptured. This results in reduced uteroplacental blood flow and potential fetal distress. Aortocaval compression resulting in sudden loss of consciousness and severe bradycardia and hypotension during cesarean section in a patient with subvalvular aortic stenosis shouming chen1,2, lan wu1,2 and xiaoqin jiang1,2 abstract background. And yet, hardly anyone is aware that a number of patients suffer from compression of blood vessels or compression of organs by abdominal blood vessels, the socalled vascular compression syndromes. Arthrogryposisrenal dysfunctioncholestasis syndrome.
388 933 1286 488 813 1078 397 645 941 144 724 569 859 1372 1184 611 1575 585 200 568 1100 1593 1280 669 564 890 254 927 1137 1322