Intraoperative Cardiac Output Trends and Blood Loss during Cesarean Section: A Retrospective Exploratory Analysis
Sooyeon Han, Satoshi ToyamaAbstract
Context:
Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality after cesarean section. Conventional hemodynamic markers, including heart rate (HR), blood pressure, and shock index, provide inconsistent early recognition of blood loss. Non-invasive cardiac output (CO) monitoring may add physiological insight.
Aims:
To evaluate whether intraoperative changes in non-invasively measured CO are associated with blood loss during cesarean section.
Settings and Design:
A single-center retrospective exploratory study.
Methods and Materials:
Women undergoing cesarean section with non-invasive continuous CO monitoring were included. CO and other hemodynamic parameters were recorded at baseline, at the baby’s delivery, and at 0–15 minutes after placental delivery. The percentage change in the minimum CO after placental delivery was calculated relative to the CO at placental delivery.
Statistical Analysis Used:
Spearman correlation, Friedman analysis with Bonferroni correction, and receiver operating characteristic analysis.
Results:
Eighty-three women were analyzed. CO increased transiently after placental delivery and then declined. Median time to the minimum CO within 15 minutes after placental delivery was 10 minutes (IQR 4.5 to 14.0), with a median decrease of −7.8% (IQR − 13.0 to 3.4). A greater decline in CO correlated with higher blood loss (
Conclusion:
Although discriminatory accuracy was modest, monitoring non-invasive CO trends during cesarean section may provide additional physiological context for maternal hemodynamic adaptation to blood loss. These findings require confirmation in larger prospective studies.