Obstet Gynecol Sci.  2022 Jul;65(4):325-334. 10.5468/ogs.22063.

Non-invasive continuous blood pressure monitoring using the ClearSight system for pregnant women at high risks of post-partum hemorrhage: comparison with invasive blood pressure monitoring during cesarean section

• Misugi T
• Juri T
• Suehiro K
• Kitada K
• Kurihara Y
• Tahara M
• Hamuro A
• Nakano A
• Koyama M
• Mori T
• Tachibana D

• KMID: 2531841
• DOI: http://doi.org/10.5468/ogs.22063

Abstract

Objective
This study aimed to investigate the accuracy and precision of continuous, non-invasive blood pressure obtained using the ClearSight system by comparing it with invasive arterial blood pressure, and to assess the hemodynamic changes using invasive methods and the ClearSight system in patients undergoing cesarean section.
Methods
Arterial pressure was measured invasively with an intra-arterial catheter and non-invasively using the ClearSight system during cesarean section in patients with placenta previa or placenta accreta. Blood pressure measurements obtained using these two means were then compared.
Results
Total 1,277 blood pressure measurement pairs were collected from 21 patients. Under Bland-Altman analysis, the ClearSight system demonstrated an acceptable accuracy with a bias and standard deviation of 8.8±13.4 mmHg for systolic blood pressure, -6.3±7.1 mmHg for diastolic blood pressure, and -2.7±8.0 mmHg for median blood pressure. Cardiac index levels were significantly elevated during fetal delivery and 5 minutes after placental removal, and systemic vascular resistance index levels were significantly decreased during fetal delivery and 40 minutes after placental removal.
Conclusion
In patients undergoing cesarean section, the ClearSight system showed excellent accuracy and precision compared to that of the currently used invasive monitoring system.

Keyword

Blood pressure monitor; Cesarean section; Spinal anesthesia; Postpartum hemorrhage

Figure

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  Fig. 1 Flow diagram of the present study.

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  Fig. 2 Regression plot comparing blood pressure measured by the arterial catheter and the ClearSight system for all measurements. (A) Systolic blood pressure (SBP). SBPAC and SBPCS indicate SBP measured by arterial catheter and the ClearSight system, respectively. (B) Diastolic blood pressure (DBP). DBPAC and DBPCS indicate DBP measured by arterial catheter and the ClearSight system, respectively. (C) Mean blood pressure (MBP). MBPAC and MBPCS indicate MBP measured by arterial catheter and the ClearSight system, respectively. SB-PCS, SBP measured by the ClearSight system; CC, correlation coefficient; SBPAC, SBP measured by arterial catheter; DBPCS, DBP measured by the ClearSight system; DBPAC, DBP measured by arterial catheter; MBPCS, MBP measured by the ClearSight system; MBPAC, MBP measured by arterial catheter.

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  Fig. 3 Bland-Altman analysis evaluating the agreement of blood pressure measured by arterial catheter and the ClearSight system for all measurements. The same symbol (shape and color) indicates the data from the same patient. (A) Systolic blood pressure (SBP). (B) Diastolic blood pressure (DBP). (C) Mean blood pressure (MBP). SBPAC, SBP measured by arterial catheter; SBPCS, SBP measured by the ClearSight system; SD, standard deviation; DBPAC, DBP measured by arterial catheter; DBPCS, DBP measured by the ClearSight system; MBPAC, MBP measured by arterial catheter; MBPCS, MBP measured by the ClearSight system.

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  Fig. 4 Transition of representative 12 points of measurement during cesarean section obtained from the ClearSight system. These time points are pre-operative (Pre), at the time of fetal delivery (FD), at the time of placental removal (PR), 5, 10, 15, 20, 25, 30, 40, 50, and 60 minutes after placental removal. We compared each measurement with Pre value. (A) Mean blood pressure measured by arterial catheter. (B) Mean blood pressure measured by the ClearSight system. (C) Cardiac index. (D) Systemic vascular resistance index. m, mintues. *P<0.05.

Reference

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