Ability to track hemodynamic changes in parturients undergoing cesarean section using central venous pressure, stroke volume, and stroke volume variation: a prospective observational study

Abstract Fluid management in parturients with massive bleeding is often difficult to gauge because there are no reliable indicators of the fluid status. Thirty-two eligible parturients with pernicious placenta previa at the Qilu Hospital of Shandong University between January 2019 and August 2021 were included in this prospective observational study. All subjects were monitored continuously to measure the central venous pressure (CVP), stroke volume (SV), and stroke volume variation (SVV) along with standard monitoring. The primary outcome is the sensitivity and specificity of HR, CVP, SV, and SVV to diagnose hemodynamic instability induced by massive blood loss, which was evaluated by receiver operating characteristic (ROC) curve analysis. The areas under the ROC curve for HR, CVP, SVV, and SV to diagnose hemodynamic instability were 0.83 (sensitivity: 0.62, specificity: 1), 0.79 (sensitivity: 0.46, specificity: 1), 0.72 (sensitivity: 0.62, specificity: 0.95), and 0.64 (sensitivity: 0.69, specificity: 0.68), respectively. Massive blood loss, general anaesthesia induction, and balloon deflation caused significant changes in corresponding hemodynamic indicators. The CVP, SV, and SVV can effectively track the hemodynamic changes in parturients undergoing cesarean section. The sensitivity is low and the specificity is high for HR, CVP, and SVV to diagnose massive blood loss-induced hemodynamic instability.