Intraabdominal pressure and its relationship with organ dysfunction in patients scheduled for elective cesarean section: effect of supine vs. left lateral tilt position

INTRODUCTION Intraabdominal pressure (IAP) is related to clinical outcome of patients. It is measured as intravesical pressure through Foley catheter, in supine position. During pregnancy, there is data showing elevated IAP, and also a suggestion that it may be a false increase due to pressure on urinary bladder by the gravid uterus in supine position. Additionally, it is not known whether the elevated IAP during pregnancy is merely a physiological change, or is associated with impairment of organ functions. We thus aimed to establish normal value of IAP in supine (IAPsupine ) as well as 10° left lateral (IAPlateral-tilt ) positions, and their association with organ functions as well as certain maternal risk characteristics. MATERIAL AND METHODS This prospective cross sectional cohort study included 100 consenting parturients with term gestation posted for elective cesarean section under single-shot subarachnoid block. IAP was measured via indwelling Foley catheter with a transducer connected to it, as per recommended technique. Organ dysfunction was defined as Sequential Organ Failure Assessment (SOFA) sub-score ≥1 for the particular system. TRIAL REGISTRATION ctri.gov.in (CTRI/2017/11/010527). RESULTS The IAPsupine was significantly higher than IAPlateral-tilt (13.8 ± 2.4 vs. 12 ± 2.3 mmHg) (P 0.05). There was a significant correlation of intraabdominal hypertension when considering IAPsupine or IAPlateral-tilt , with obesity (P = 0.004 and 0.000 respectively), as well as preeclampsia (P = 0.006 and 0.000 respectively). CONCLUSIONS In non-laboring patients undergoing elective cesarean section, IAP is significantly higher in supine vs. 10° left lateral position. In neither position is IAP significantly associated with organ dysfunction. Thus, the usual recommendation of a supine position for measuring IAP to diagnose intraabdominal hypertension, formulated consequent to its pathological effects on organ functions, may not be applicable to pregnant patients and needs urgent validation studies.