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The effect of prone positioning on maternal haemodynamics and fetal wellbeing in the third trimester–A primary cohort study with a scoping review

Laura Ormesher Orcid Logo, Jessica Catchpole, Linda Peacock, Heather Pitt, Anastasia Fabian-Hunt, Dexter Hayes, CLAUDIA POPP, Jason M. Carson Orcid Logo, Raoul van Loon Orcid Logo, Lynne Warrander, Karli Büchling, Alexander E. P. Heazell

PLOS ONE, Volume: 18, Issue: 10, Start page: e0287804

Swansea University Authors: CLAUDIA POPP, Jason M. Carson Orcid Logo, Raoul van Loon Orcid Logo

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DOI (Published version): 10.1371/journal.pone.0287804

Abstract

Introduction: Supine sleep position is associated with stillbirth, likely secondary to inferior vena cava compression, and a reduction in cardiac output (CO) and uteroplacental perfusion. Evidence for the effects of prone position in pregnancy is less clear. This study aimed to determine the effect...

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Published in: PLOS ONE
ISSN: 1932-6203
Published: Public Library of Science (PLoS) 2023
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Carson</name><active>true</active><ethesisStudent>true</ethesisStudent></author><author><sid>880b30f90841a022f1e5bac32fb12193</sid><ORCID>0000-0003-3581-5827</ORCID><firstname>Raoul</firstname><surname>van Loon</surname><name>Raoul van Loon</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2023-09-21</date><abstract>Introduction: Supine sleep position is associated with stillbirth, likely secondary to inferior vena cava compression, and a reduction in cardiac output (CO) and uteroplacental perfusion. Evidence for the effects of prone position in pregnancy is less clear. This study aimed to determine the effect maternal prone position on maternal haemodynamics and fetal heart rate, compared with left lateral position. Methods: Twenty-one women &gt;28 weeks’ gestation underwent non-invasive CO monitoring (Cheetah) every 5 minutes and continuous fetal heart rate monitoring (MONICA) in left lateral (20 minutes), prone (30 minutes), followed by left lateral (20 minutes). Anxiety and comfort were assessed by questionnaires. Regression analyses (adjusted for time) compared variables between positions. The information derived from the primary study was used in an existing mathematical model of maternal circulation in pregnancy, to determine whether occlusion of the inferior vena cava could account for the observed effects. In addition, a scoping review was performed to identify reported clinical, haemodynamic and fetal effects of maternal prone position; studies were included if they reported clinical outcomes or effects or maternal prone position in pregnancy. Study records were grouped by publication type for ease of data synthesis and critical analysis. Meta-analysis was performed where there were sufficient studies. Results: Maternal blood pressure (BP) and total vascular resistance (TVR) were increased in prone (sBP 109 vs 104 mmHg, p = 0.03; dBP 74 vs 67 mmHg, p = 0.003; TVR 1302 vs 1075 dyne.s-1cm-5, p = 0.03). CO was reduced in prone (5.7 vs 7.1 mL/minute, p = 0.003). Fetal heart rate, variability and decelerations were unaltered. However, fetal accelerations were less common in prone position (86% vs 95%, p = 0.03). Anxiety was reduced after the procedure, compared to beforehand (p = 0.002), despite a marginal decline in comfort (p = 0.04).The model predicted that if occlusion of the inferior vena cava occurred, the sBP, dBP and CO would generally decrease. However, the TVR remained relatively consistent, which implies that the MAP and CO decrease at a similar rate when occlusion occurs. The scoping review found that maternal and fetal outcomes from 47 included case reports of prone positioning during pregnancy were generally favourable. Meta-analysis of three prospective studies investigating maternal haemodynamic effects of prone position found an increase in sBP and maternal heart rate, but no effect on respiratory rate, oxygen saturation or baseline fetal heart rate (though there was significant heterogeneity between studies). Conclusion: Prone position was associated with a reduction in CO but an uncertain effect on fetal wellbeing. The decline in CO may be due to caval compression, as supported by the computational model. Further work is needed to optimise the safety of prone positioning in pregnancy. Trial registration: This trial was registered at clinicaltrials.gov (NCT04586283).</abstract><type>Journal Article</type><journal>PLOS ONE</journal><volume>18</volume><journalNumber>10</journalNumber><paginationStart>e0287804</paginationStart><paginationEnd/><publisher>Public Library of Science (PLoS)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1932-6203</issnElectronic><keywords>Maternal haemodynamics, prone positioning, third trimester, fetal wellbeing</keywords><publishedDay>11</publishedDay><publishedMonth>10</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-10-11</publishedDate><doi>10.1371/journal.pone.0287804</doi><url>http://dx.doi.org/10.1371/journal.pone.0287804</url><notes/><college>COLLEGE NANME</college><CollegeCode>COLLEGE CODE</CollegeCode><institution>Swansea University</institution><apcterm/><funders>AH, KB, LO received funding from the Dowager Countess Eleanor Peel Medical Research Trust (https://peeltrust.com/).</funders><projectreference/><lastEdited>2024-04-11T00:42:01.5284196</lastEdited><Created>2023-09-21T15:14:10.6500474</Created><path><level id="1">Faculty of Science and Engineering</level><level id="2">School of Engineering and Applied Sciences - Biomedical Engineering</level></path><authors><author><firstname>Laura</firstname><surname>Ormesher</surname><orcid>0000-0002-1820-5800</orcid><order>1</order></author><author><firstname>Jessica</firstname><surname>Catchpole</surname><order>2</order></author><author><firstname>Linda</firstname><surname>Peacock</surname><order>3</order></author><author><firstname>Heather</firstname><surname>Pitt</surname><order>4</order></author><author><firstname>Anastasia</firstname><surname>Fabian-Hunt</surname><order>5</order></author><author><firstname>Dexter</firstname><surname>Hayes</surname><order>6</order></author><author><firstname>CLAUDIA</firstname><surname>POPP</surname><order>7</order></author><author><firstname>Jason M.</firstname><surname>Carson</surname><orcid>0000-0001-6634-9123</orcid><order>8</order></author><author><firstname>Raoul</firstname><surname>van Loon</surname><orcid>0000-0003-3581-5827</orcid><order>9</order></author><author><firstname>Lynne</firstname><surname>Warrander</surname><order>10</order></author><author><firstname>Karli</firstname><surname>Büchling</surname><order>11</order></author><author><firstname>Alexander E. 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spelling v2 64589 2023-09-21 The effect of prone positioning on maternal haemodynamics and fetal wellbeing in the third trimester–A primary cohort study with a scoping review 390258a988aabbfb83515b831a281289 CLAUDIA POPP CLAUDIA POPP true false d0fe636d559f9023182e4315c2940595 0000-0001-6634-9123 Jason M. Carson Jason M. Carson true true 880b30f90841a022f1e5bac32fb12193 0000-0003-3581-5827 Raoul van Loon Raoul van Loon true false 2023-09-21 Introduction: Supine sleep position is associated with stillbirth, likely secondary to inferior vena cava compression, and a reduction in cardiac output (CO) and uteroplacental perfusion. Evidence for the effects of prone position in pregnancy is less clear. This study aimed to determine the effect maternal prone position on maternal haemodynamics and fetal heart rate, compared with left lateral position. Methods: Twenty-one women >28 weeks’ gestation underwent non-invasive CO monitoring (Cheetah) every 5 minutes and continuous fetal heart rate monitoring (MONICA) in left lateral (20 minutes), prone (30 minutes), followed by left lateral (20 minutes). Anxiety and comfort were assessed by questionnaires. Regression analyses (adjusted for time) compared variables between positions. The information derived from the primary study was used in an existing mathematical model of maternal circulation in pregnancy, to determine whether occlusion of the inferior vena cava could account for the observed effects. In addition, a scoping review was performed to identify reported clinical, haemodynamic and fetal effects of maternal prone position; studies were included if they reported clinical outcomes or effects or maternal prone position in pregnancy. Study records were grouped by publication type for ease of data synthesis and critical analysis. Meta-analysis was performed where there were sufficient studies. Results: Maternal blood pressure (BP) and total vascular resistance (TVR) were increased in prone (sBP 109 vs 104 mmHg, p = 0.03; dBP 74 vs 67 mmHg, p = 0.003; TVR 1302 vs 1075 dyne.s-1cm-5, p = 0.03). CO was reduced in prone (5.7 vs 7.1 mL/minute, p = 0.003). Fetal heart rate, variability and decelerations were unaltered. However, fetal accelerations were less common in prone position (86% vs 95%, p = 0.03). Anxiety was reduced after the procedure, compared to beforehand (p = 0.002), despite a marginal decline in comfort (p = 0.04).The model predicted that if occlusion of the inferior vena cava occurred, the sBP, dBP and CO would generally decrease. However, the TVR remained relatively consistent, which implies that the MAP and CO decrease at a similar rate when occlusion occurs. The scoping review found that maternal and fetal outcomes from 47 included case reports of prone positioning during pregnancy were generally favourable. Meta-analysis of three prospective studies investigating maternal haemodynamic effects of prone position found an increase in sBP and maternal heart rate, but no effect on respiratory rate, oxygen saturation or baseline fetal heart rate (though there was significant heterogeneity between studies). Conclusion: Prone position was associated with a reduction in CO but an uncertain effect on fetal wellbeing. The decline in CO may be due to caval compression, as supported by the computational model. Further work is needed to optimise the safety of prone positioning in pregnancy. Trial registration: This trial was registered at clinicaltrials.gov (NCT04586283). Journal Article PLOS ONE 18 10 e0287804 Public Library of Science (PLoS) 1932-6203 Maternal haemodynamics, prone positioning, third trimester, fetal wellbeing 11 10 2023 2023-10-11 10.1371/journal.pone.0287804 http://dx.doi.org/10.1371/journal.pone.0287804 COLLEGE NANME COLLEGE CODE Swansea University AH, KB, LO received funding from the Dowager Countess Eleanor Peel Medical Research Trust (https://peeltrust.com/). 2024-04-11T00:42:01.5284196 2023-09-21T15:14:10.6500474 Faculty of Science and Engineering School of Engineering and Applied Sciences - Biomedical Engineering Laura Ormesher 0000-0002-1820-5800 1 Jessica Catchpole 2 Linda Peacock 3 Heather Pitt 4 Anastasia Fabian-Hunt 5 Dexter Hayes 6 CLAUDIA POPP 7 Jason M. Carson 0000-0001-6634-9123 8 Raoul van Loon 0000-0003-3581-5827 9 Lynne Warrander 10 Karli Büchling 11 Alexander E. P. Heazell 12 64589__28822__1df3a5c7579842d7996515ec181c32ef.pdf 64589.VOR.pdf 2023-10-18T16:48:34.5369086 Output 2339609 application/pdf Version of Record true © 2023 Ormesher et al. Distributed under the terms of a Creative Commons Attribution 4.0 License (CC BY 4.0). true eng https://creativecommons.org/licenses/by/4.0/
title The effect of prone positioning on maternal haemodynamics and fetal wellbeing in the third trimester–A primary cohort study with a scoping review
spellingShingle The effect of prone positioning on maternal haemodynamics and fetal wellbeing in the third trimester–A primary cohort study with a scoping review
CLAUDIA POPP
Jason M. Carson
Raoul van Loon
title_short The effect of prone positioning on maternal haemodynamics and fetal wellbeing in the third trimester–A primary cohort study with a scoping review
title_full The effect of prone positioning on maternal haemodynamics and fetal wellbeing in the third trimester–A primary cohort study with a scoping review
title_fullStr The effect of prone positioning on maternal haemodynamics and fetal wellbeing in the third trimester–A primary cohort study with a scoping review
title_full_unstemmed The effect of prone positioning on maternal haemodynamics and fetal wellbeing in the third trimester–A primary cohort study with a scoping review
title_sort The effect of prone positioning on maternal haemodynamics and fetal wellbeing in the third trimester–A primary cohort study with a scoping review
author_id_str_mv 390258a988aabbfb83515b831a281289
d0fe636d559f9023182e4315c2940595
880b30f90841a022f1e5bac32fb12193
author_id_fullname_str_mv 390258a988aabbfb83515b831a281289_***_CLAUDIA POPP
d0fe636d559f9023182e4315c2940595_***_Jason M. Carson
880b30f90841a022f1e5bac32fb12193_***_Raoul van Loon
author CLAUDIA POPP
Jason M. Carson
Raoul van Loon
author2 Laura Ormesher
Jessica Catchpole
Linda Peacock
Heather Pitt
Anastasia Fabian-Hunt
Dexter Hayes
CLAUDIA POPP
Jason M. Carson
Raoul van Loon
Lynne Warrander
Karli Büchling
Alexander E. P. Heazell
format Journal article
container_title PLOS ONE
container_volume 18
container_issue 10
container_start_page e0287804
publishDate 2023
institution Swansea University
issn 1932-6203
doi_str_mv 10.1371/journal.pone.0287804
publisher Public Library of Science (PLoS)
college_str Faculty of Science and Engineering
hierarchytype
hierarchy_top_id facultyofscienceandengineering
hierarchy_top_title Faculty of Science and Engineering
hierarchy_parent_id facultyofscienceandengineering
hierarchy_parent_title Faculty of Science and Engineering
department_str School of Engineering and Applied Sciences - Biomedical Engineering{{{_:::_}}}Faculty of Science and Engineering{{{_:::_}}}School of Engineering and Applied Sciences - Biomedical Engineering
url http://dx.doi.org/10.1371/journal.pone.0287804
document_store_str 1
active_str 0
description Introduction: Supine sleep position is associated with stillbirth, likely secondary to inferior vena cava compression, and a reduction in cardiac output (CO) and uteroplacental perfusion. Evidence for the effects of prone position in pregnancy is less clear. This study aimed to determine the effect maternal prone position on maternal haemodynamics and fetal heart rate, compared with left lateral position. Methods: Twenty-one women >28 weeks’ gestation underwent non-invasive CO monitoring (Cheetah) every 5 minutes and continuous fetal heart rate monitoring (MONICA) in left lateral (20 minutes), prone (30 minutes), followed by left lateral (20 minutes). Anxiety and comfort were assessed by questionnaires. Regression analyses (adjusted for time) compared variables between positions. The information derived from the primary study was used in an existing mathematical model of maternal circulation in pregnancy, to determine whether occlusion of the inferior vena cava could account for the observed effects. In addition, a scoping review was performed to identify reported clinical, haemodynamic and fetal effects of maternal prone position; studies were included if they reported clinical outcomes or effects or maternal prone position in pregnancy. Study records were grouped by publication type for ease of data synthesis and critical analysis. Meta-analysis was performed where there were sufficient studies. Results: Maternal blood pressure (BP) and total vascular resistance (TVR) were increased in prone (sBP 109 vs 104 mmHg, p = 0.03; dBP 74 vs 67 mmHg, p = 0.003; TVR 1302 vs 1075 dyne.s-1cm-5, p = 0.03). CO was reduced in prone (5.7 vs 7.1 mL/minute, p = 0.003). Fetal heart rate, variability and decelerations were unaltered. However, fetal accelerations were less common in prone position (86% vs 95%, p = 0.03). Anxiety was reduced after the procedure, compared to beforehand (p = 0.002), despite a marginal decline in comfort (p = 0.04).The model predicted that if occlusion of the inferior vena cava occurred, the sBP, dBP and CO would generally decrease. However, the TVR remained relatively consistent, which implies that the MAP and CO decrease at a similar rate when occlusion occurs. The scoping review found that maternal and fetal outcomes from 47 included case reports of prone positioning during pregnancy were generally favourable. Meta-analysis of three prospective studies investigating maternal haemodynamic effects of prone position found an increase in sBP and maternal heart rate, but no effect on respiratory rate, oxygen saturation or baseline fetal heart rate (though there was significant heterogeneity between studies). Conclusion: Prone position was associated with a reduction in CO but an uncertain effect on fetal wellbeing. The decline in CO may be due to caval compression, as supported by the computational model. Further work is needed to optimise the safety of prone positioning in pregnancy. Trial registration: This trial was registered at clinicaltrials.gov (NCT04586283).
published_date 2023-10-11T00:42:07Z
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