ST segment depression during labor and delivery

J. P. Mathew, L. A. Fleisher, J. A. Rinehouse, F. B. Sevarino, R. S. Sinatra, A. H. Nelson, E. K. Prokop, S. H. Rosenbaum

Research output: Contribution to journalArticle

Abstract

ECG changes suggestive of myocardial ischemia are common during cesarean delivery under regional anesthesia. To determine the time course, duration, and significance of these ECG changes, we monitored 111 parturients with continuous ambulatory ECG (Holter) during and after cesarean delivery. Twenty-two parturients undergoing vaginal delivery were similarly monitored. ST segment depression was present in 25% of patients undergoing cesarean delivery but was not found in those patients delivering vaginally. ST segment elevation was not detected in either group. The incidence of ST segment depression during cesarean delivery was similar with epidural (29%), spinal (17%), and general (18%) anesthesia, occurring most commonly in the 30 min following delivery (P <0.001). Transthoracic echocardiographic imaging was performed in 23 patients undergoing cesarean section. Five of the 23 patients had seven episodes of intraoperative ST segment depression. Regional wall motion abnormalities were not present in any patient. A decrease in ejection fraction area greater than 15% from baseline or from previous interval ejection fraction area was present during four episodes of ST change. Three episodes of ST depression were not associated with significant decreases in ejection fraction area. Precordial Doppler monitoring for detection of venous air embolism in 25 patients revealed no association between the occurrence of venous air embolism and ST segment depression. We conclude that although significant myocardial impairment during cesarean delivery does not occur, episodes of ST depression may not all be merely an artifact of parturition.

Original languageEnglish (US)
Pages (from-to)635-641
Number of pages7
JournalAnesthesiology
Volume77
Issue number4
DOIs
StatePublished - 1992
Externally publishedYes

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Air Embolism
Electrocardiography
Parturition
Conduction Anesthesia
Cesarean Section
Artifacts
General Anesthesia
Myocardial Ischemia
Incidence

Keywords

  • Anesthesia, obstetric: cesarean delivery
  • Heart: ischemia
  • Monitoring: Doppler; echocardiography; electrocardiography

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Mathew, J. P., Fleisher, L. A., Rinehouse, J. A., Sevarino, F. B., Sinatra, R. S., Nelson, A. H., ... Rosenbaum, S. H. (1992). ST segment depression during labor and delivery. Anesthesiology, 77(4), 635-641. https://doi.org/10.1097/00000542-199210000-00004

ST segment depression during labor and delivery. / Mathew, J. P.; Fleisher, L. A.; Rinehouse, J. A.; Sevarino, F. B.; Sinatra, R. S.; Nelson, A. H.; Prokop, E. K.; Rosenbaum, S. H.

In: Anesthesiology, Vol. 77, No. 4, 1992, p. 635-641.

Research output: Contribution to journalArticle

Mathew, JP, Fleisher, LA, Rinehouse, JA, Sevarino, FB, Sinatra, RS, Nelson, AH, Prokop, EK & Rosenbaum, SH 1992, 'ST segment depression during labor and delivery', Anesthesiology, vol. 77, no. 4, pp. 635-641. https://doi.org/10.1097/00000542-199210000-00004
Mathew JP, Fleisher LA, Rinehouse JA, Sevarino FB, Sinatra RS, Nelson AH et al. ST segment depression during labor and delivery. Anesthesiology. 1992;77(4):635-641. https://doi.org/10.1097/00000542-199210000-00004
Mathew, J. P. ; Fleisher, L. A. ; Rinehouse, J. A. ; Sevarino, F. B. ; Sinatra, R. S. ; Nelson, A. H. ; Prokop, E. K. ; Rosenbaum, S. H. / ST segment depression during labor and delivery. In: Anesthesiology. 1992 ; Vol. 77, No. 4. pp. 635-641.
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