Cardiac Output-Guided Resuscitation of the Uterus: An Obese Patient Has Dysfunctional Labor Which Resolves with Position Change. Coincidence or Possible Therapy?

  • Thomas L. Archer


A morbidly obese 36-year-old woman, G2P1, is in labor with her second baby and her pain has been well controlled by an epidural placed with preprocedural ultrasound. She delivered her first baby—who weighed ten pounds—7 years ago and says she almost had to have a cesarean delivery (CD) because her uterus “got lazy,” despite oxytocin augmentation (L-1).


  1. 1.
    Wray S. Insights from physiology into myometrial function and dysfunction. Exp Physiol. 2015;100(12):1468–76.CrossRefGoogle Scholar
  2. 2.
    Zhang J, Bricker L, Wray S, Quenby S. Poor uterine contractility in obese women. BJOG. 2007;114(3):343–8. Epub 2007 Jan 22.CrossRefGoogle Scholar
  3. 3.
    Wray S. Insights into the uterus. Exp Physiol. 2007;92(4):621–31. Epub 2007 May 4.CrossRefGoogle Scholar
  4. 4.
    Quenby S, Pierce SJ, Brigham S, Wray S. Dysfunctional labor and myometrial lactic acidosis. Obstet Gynecol. 2004;103(4):718–23.CrossRefGoogle Scholar
  5. 5.
    Wiberg-Itzel E, Wray S, Åkerud H. A randomized controlled trial of a new treatment for labor dystocia. J Matern Fetal Neonatal Med. 2018;31(17):2237–44. Epub 2017 Jun 22.CrossRefGoogle Scholar
  6. 6.
    Humphries A, Stone P, Mirjalili SA. The collateral venous system in late pregnancy: a systematic review of the literature. Clin Anat. 2017;30(8):1087–95. Epub 2017 Aug 11.CrossRefGoogle Scholar
  7. 7.
    Sawchuck DJ, Wittmann BK. Pre-eclampsia renamed and reframed: intra-abdominal hypertension in pregnancy. Med Hypotheses. 2014;83(5):619–32. Epub 2014 Aug 12.CrossRefGoogle Scholar
  8. 8.
    Archer T, Shapiro A, Suresh P. Cardiac output measurement, by means of electrical velocimetry, may be able to determine optimum maternal position during gestation, labour and cesarean delivery, by preventing vena caval compression and maximising cardiac output and placental perfusion. Anaesth Intensive Care. 2011;39(2):308–11.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Archer T, Shapiro A, Suresh P. Maximisation of maternal cardiac output during labor might help to prevent not only fetal hypoxaemia but also myometrial ischaemia, dysfunctional labour, uterine atony and postpartum endometritis. Anaesth Intensive Care. 2011;39(4):774–5.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Archer TL, Suresh PJ, Ballas J. Don’t forget aortocaval compression when imaging abdominal veins in pregnant patients. Ultrasound Obstet Gynecol. 2011; (Epub ahead of print).Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Thomas L. Archer
    • 1
  1. 1.Department of Anesthesiology 2008–2015University of California San Diego School of MedicineSan DiegoUSA

Personalised recommendations