Abstract
Objective:
The objective of this study was to report thoracic impedance cardiography (ICG) measurements and compare them with echocardiography (echo) measurements throughout pregnancy and in varied maternal positions.
Method:
A prospective cohort study involving 28 healthy parturients was performed using ICG and echo at three time points and in two maternal positions. Pearson’s correlations, Bland–Altman plots and paired t-tests were used for statistical analysis.
Result:
Significant agreements between many but not all ICG and echo contractility, flow and resistance measurements were demonstrated. Differences in stroke volume (SV) due to maternal position were also detected by ICG in the antepartum (AP) period. Significant trends were observed by ICG for cardiac output and thoracic fluid content (TFC; P<0.025) with advancing pregnancy stages.
Conclusion:
ICG and echo demonstrate significant correlations in some but not all measurements of cardiac function. ICG has the ability to detect small changes in SV associated with maternal position change. ICG measurements reflected maximal cardiac contractility in the a AP period yet reflected a decrease in contractility and an increase in TFC in the postpartum period.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Burlingame J, Horiuchi B, Ohana P, Onaka A, Sauvage LM . The contribution of heart disease to pregnancy-related mortality according to the pregnancy mortality surveillance system. J Perinatol 2012; 32 (3): 163–169.
Whitehead SJ, Berg CJ, Chang J . Pregnancy-related mortality due to cardiomyopathy: United States, 1991-1997. Obstet Gynecol 2003; 102 (6): 1326–1331.
Fett JD . Pregnancy-related mortality due to cardiomyopathy: United States, 1991-1997. Obstet Gynecol 2004; 103 (6): 1342 author reply 1343.
Berg CJ, Harper MA, Atkinson SM, Bell EA, Brown HL, Hage ML et al. Preventability of pregnancy-related deaths: results of a state-wide review. Obstet Gynecol 2005; 106 (6): 1228–1234.
Berg CJ, Chang J, Callaghan WM, Whitehead SJ . Pregnancy-related mortality in the United States, 1991-1997. Obstet Gynecol 2003; 101 (2): 289–296.
van Oppen AC, Stigter RH, Bruinse HW . Cardiac output in normal pregnancy: a critical review. Obstet Gynecol 1996; 87 (2): 310–318.
Hennessy TG, MacDonald D, Hennessy MS, Maguire M, Blake S, McCann HA et al. Serial changes in cardiac output during normal pregnancy: a Doppler ultrasound study. Eur J Obstet Ggynecol Rreprod Biol 1996; 70 (2): 117–122.
Clark SL, Cotton DB, Lee W, Bishop C, Hill T, Southwick J et al. Central hemodynamic assessment of normal term pregnancy. Am J Obstet Gynecol 1989; 161 (6 Pt 1): 1439–1442.
Clapp JF 3rd, Seaward BL, Sleamaker RH, Hiser J . Maternal physiologic adaptations to early human pregnancy. Am J Obstet Gynecol 1988; 159 (6): 1456–1460.
Atkins AF, Watt JM, Milan P, Davies P, Crawford JS . A longitudinal study of cardiovascular dynamic changes throughout pregnancy. Eur J Obstet Ggynecol Rreprod Biol 1981; 12 (4): 215–224.
Ueland K, Metcalfe J . Circulatory changes in pregnancy. Clinical Obstet Gynecol 1975; 18 (3): 41–50.
Lund CJ, Donovan JC . Blood volume during pregnancy. Significance of plasma and red cell volumes. Am J Obstet Gynecol 1967; 98 (3): 394–403.
Hankins GD, Harvey CJ, Clark SL, Uckan EM, Van Hook JW . The effects of maternal position and cardiac output on intrapulmonary shunt in normal third-trimester pregnancy. Obstet Gynecol 1996; 88 (3): 327–330.
Atkins AJ, Watt JM, Milan P, Davies P, Crawford JS . The influence of posture upon cardiovascular dynamics throughout pregnancy. Eur J Obstet Ggynecol Rreprod Biol 1981; 12 (6): 357–372.
Kerkkamp HJ, Heethaar RM . A comparison of bioimpedance and echocardiography in measuring systolic heart function in cardiac patients. Ann NY Acad Sci 1999; 873: 149–154.
Albert NM, Hail MD, Li J, Young JB . Equivalence of the bioimpedance and thermodilution methods in measuring cardiac output in hospitalized patients with advanced, decompensated chronic heart failure. Am J Crit Care 2004; 13 (6): 469–479.
Drazner MH, Thompson B, Rosenberg PB, Kaiser PA, Boehrer JD, Baldwin BJ et al. Comparison of impedance cardiography with invasive hemodynamic measurements in patients with heart failure secondary to ischemic or nonischemic cardiomyopathy. Am J Cardiol 2002; 89 (8): 993–995.
Greenberg BH, Hermann DD, Pranulis MF, Lazio L, Cloutier D . Reproducibility of impedance cardiography hemodynamic measures in clinically stable heart failure patients. Congest Heart Fail 2000; 6 (2): 74–80.
Van De Water JM, Miller TW, Vogel RL, Mount BE, Dalton ML . Impedance cardiography: the next vital sign technology? Chest 2003; 123 (6): 2028–2033.
Tang WH, Tong W . Measuring impedance in congestive heart failure: current options and clinical applications. Am Heart J 2009; 157 (3): 402–411.
Yancy C, Abraham WT . Noninvasive hemodynamic monitoring in heart failure: utilization of impedance cardiography. Congest Heart Fail 2003; 9 (5): 241–250.
Armstrong W, Ryan T . Feigenbaum’s Echocardiography 7th edn. Philadelphia, PA, USA: Lippincott Williams & Wilkins, 2009.
Boudoulas H . Systolic time intervals. Eur Heart J 1990; 11 (Suppl I): 93–104.
Mattar JA, Shoemaker WC, Diament D, Lomar A, Lopes AC, De Freitas E et al. Systolic and diastolic time intervals in the critically ill patient. Crit Care Med 1991; 19 (11): 1382–1386.
Ranaei R, Heywood J, Elatre WA . Assessment of contractility and total arterial compliance by impedance cardiography determined parameters. J Card Fail 2002; 8 (4 suppl): S97.
Myhrman P, Granerus G, Karlsson K, Lundgren Y . Cardiac output in normal pregnancy measured by impedance cardiography. Scand J Clin Lab Investig 1982; 42 (6): 513–520.
Milsom I, Forssman L, Biber B, Dottori O, Sivertsson R . Measurement of cardiac stroke volume during cesarean section: a comparison between impedance cardiography and the dye dilution technique. Acta anaesthesiol Scand 1983; 27 (5): 421–426.
Milsom I, Forssman L, Sivertsson R, Dottori O . Measurement of cardiac stroke volume by impedance cardiography in the last trimester of pregnancy. Acta Obstet Gynecol Scand 1983; 62 (5): 473–479.
de Swiet M, Talbert DG . The measurement of cardiac output by electrical impedance plethysmography in pregnancy. Are the assumptions valid? Br J Obstet Gynaecol 1986; 93 (7): 721–726.
Heethaar RM, van Oppen AC, Ottenhoff FA, Brouwer FA, Bruinse HW . Thoracic electrical bioimpedance: suitable for monitoring stroke volume during pregnancy? Eur J Obstet Gynecol Reprod Biol 1995; 58 (2): 183–190.
San-Frutos LM, Fernandez R, Almagro J, Barbancho C, Salazar F, Perez-Medina T et al. Measure of hemodynamic patterns by thoracic electrical bioimpedance in normal pregnancy and in preeclampsia. Eur J Obstet Gynecol Reprod Biol 2005; 121 (2): 149–153.
Scardo JA, Ellings J, Vermillion ST, Chauhan SP . Validation of bioimpedance estimates of cardiac output in preeclampsia. Am J Obstet Gynecol 2000; 183 (4): 911–913.
Masaki DI, Greenspoon JS, Ouzounian JG . Measurement of cardiac output in pregnancy by thoracic electrical bioimpedance and thermodilution. A preliminary report. Am J Obstet Gynecol 1989; 161 (3): 680–684.
Tihtonen KM, Koobi T, Vuolteenaho O, Huhtala HS, Uotila JT . Natriuretic peptides and hemodynamics in preeclampsia. Am J Obstet Gynecol 2007; 196 (4): 328, e321–327.
Tihtonen KM, Koobi T, Uotila JT . Arterial stiffness in preeclamptic and chronic hypertensive pregnancies. Eur J Obstet Gynecol Reprod Biol 2006; 128 (1-2): 180–186.
Tihtonen K, Koobi T, Yli-Hankala A, Huhtala H, Uotila J . Maternal haemodynamics in pre-eclampsia compared with normal pregnancy during caesarean delivery. Br J Obstet Gynaecol 2006; 113 (6): 657–663.
Tihtonen K, Koobi T, Yli-Hankala A, Uotila J . Maternal hemodynamics during cesarean delivery assessed by whole-body impedance cardiography. Acta Obstet Gynecol Scand 2005; 84 (4): 355–361.
Tihtonen K, Koobi T, Huhtala H, Uotila J . Hemodynamic adaptation during pregnancy in chronic hypertension. Hypertens Pregnancy 2007; 26 (3): 315–328.
Volman MN, Rep A, Kadzinska I, Berkhof J, van Geijn HP, Heethaar RM et al. Haemodynamic changes in the second half of pregnancy: a longitudinal, noninvasive study with thoracic electrical bioimpedance. Br J Obstet Gynaecol 2007; 114 (5): 576–581.
Newman RB, Pierre H, Scardo J . Thoracic-fluid conductivity in peripartum women with pulmonary edema. Obstet Gynecol 1999; 94 (1): 48–51.
Scardo JA, Vermillion ST, Hogg BB, Newman RB . Hemodynamic effects of oral nifedipine in preeclamptic hypertensive emergencies. Am J Obstet Gynecol 1996; 175 (2): 336–338 discussion 338-340.
Scardo J, Kiser R, Dillon A, Brost B, Newman R . Hemodynamic comparison of mild and severe preeclampsia: concept of stroke systemic vascular resistance index. J Matern Fetal Med 1996; 5 (5): 268–272.
Scardo JA, Hogg BB, Newman RB . Favorable hemodynamic effects of magnesium sulfate in preeclampsia. Am J Obstet Gynecol 1995; 173 (4): 1249–1253.
Clark SL, Southwick J, Pivarnik JM, Cotton DB, Hankins GD, Phelan JP . A comparison of cardiac index in normal term pregnancy using thoracic electrical bio-impedance and oxygen extraction (Fick) techniques. Obstet Gynecol 1994; 83 (5 Pt 1): 669–672.
van Oppen AC, van der Tweel I, Alsbach GP, Heethaar RM, Bruinse HW . A longitudinal study of maternal hemodynamics during normal pregnancy. Obstet Gynecol 1996; 88 (1): 40–46.
Parrott CW, Burnham KM, Quale C, Lewis DL . Comparison of changes in ejection fraction to changes in impedance cardiography cardiac index and systolic time ratio. Congest Heart Fail 2004; 10 (2 Suppl 2): 11–13.
Cybulski G, Michalak E, Kozluk E, Piatkowska A, Niewiadomski W . Stroke volume and systolic time intervals: beat-to-beat comparison between echocardiography and ambulatory impedance cardiography in supine and tilted positions. Med Biol Eng Comput 2004; 42 (5): 707–711.
Acknowledgements
The project described was supported by Award No. U54RR026136 from the National Center for Research Resources (NCRR), National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCRR, NIH or The Queen’s Medical Center.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Burlingame, J., Ohana, P., Aaronoff, M. et al. Noninvasive cardiac monitoring in pregnancy: impedance cardiography versus echocardiography. J Perinatol 33, 675–680 (2013). https://doi.org/10.1038/jp.2013.35
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jp.2013.35
Keywords
This article is cited by
-
Impedance cardiography as tool for continuous hemodynamic monitoring during cesarean section: randomized, prospective double blind study
BMC Anesthesiology (2018)
-
Agreement between preload reserve measured by impedance cardiography and echocardiography during pregnancy
Archives of Gynecology and Obstetrics (2018)
-
Maternal Critical Illness
Current Anesthesiology Reports (2017)
-
A validation study of electrical cardiometry in pregnant patients using transthoracic echocardiography as the reference standard
Journal of Clinical Monitoring and Computing (2016)
-
Validation of thoracic impedance cardiography by echocardiography in healthy late pregnancy
BMC Pregnancy and Childbirth (2015)