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To investigate if sitting in flexed cross legged position for neuraxial techniques in term pregnant patients widens the size of the ultrasound acoustic window as measured by the visualized posterior longitudinal ligament length, during lumbar spine ultrasonography using longitudinal paramedian view, in comparison to the standard sitting flexed position.
This is a prospective observational study involving a total of 30 healthy term gestation pregnant patients with singleton fetuses.Patients will be randomly allocated to sit crossed leg or in standard position first. Using ultrasonography, the acoustic window for lumbar spinal anesthesia at L3-4 will be evaluated in both traditional sitting and crossed leg positions. Ultrasonography will be performed sequentially to measure the best visualized length of posterior longitudinal ligament,ligamentum flavum and interlaminar distance in the paramedian view.The scanned image will be saved to be remeasured by a third observer. Patients will be asked to score their comfort level while sitting in both positions.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Crossed leg position | Patients in this group will be randomly allocated to sit in crossed leg position first.Ultrasonography will be performed in this position to measure the best visualized length of posterior longitudinal ligament, ligamentum flavum and interlaminar distance at L3-4 lumbar level as by Operator 1 . These measurements will be recorded by Operator 2 using intrinsic caliper software.Operator 1 will not be told the measurements. |
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| Standard Sitting position | Patients in this group will be randomly allocated to sit in standard position first.Ultrasonography will be performed in this position to measure the best visualized length of posterior longitudinal ligament, ligamentum flavum and interlaminar distance at L3-4 lumbar level as by Operator 1 . These measurements will be recorded by Operator 2 using intrinsic caliper software.Operator 1 will not be told the measurements. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ultrasonography | Device | Length of Posterior Longitudianl Ligament, Ligamentum Flavum and Interlaminar distance visible in paramedian longitudinal view during lumbar spine ultrasonography in cross legged position will be compared to standard sitting position. |
| Measure | Description | Time Frame |
|---|---|---|
| PLL length | Length of the Paravertebral Longitudinal Ligament, as measured by the intrinsic ultrasound caliber tool in mm. | Up to Five minutes |
| Measure | Description | Time Frame |
|---|---|---|
| LF length | Length of the Ligamentum Flavum as measured by the intrinsic ultrasound caliber tool in mm. | Up to Five minutes |
| ILD length | Length of the interlaminar distance, as measured by the intrinsic ultrasound caliber tool in mm. |
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Inclusion Criteria:
Term gestation Singleton pregnancy 18 years or older Patients having elective cesarean delivery or induction of labor or in early labor
Exclusion Criteria:
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Pregnant patients at term in the Labour and Delivery Suite, as well as those booked for elective cesarean sections who meet the inclusion criteria.
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| Name | Affiliation | Role |
|---|---|---|
| Indu Singh, FRCPC | Western University | Principal Investigator |
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| Type | Date | Date Unknown |
|---|---|---|
| Release | Feb 24, 2020 | |
| Reset | Mar 6, 2020 |
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| Release Date | Unrelease Date | Unrelease Date Unknown | Reset Date | MCP Release Number |
|---|---|---|---|---|
| Feb 24, 2020 | Mar 6, 2020 |
| ID | Term |
|---|---|
| D014463 | Ultrasonography |
| ID | Term |
|---|---|
| D003952 | Diagnostic Imaging |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
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| Up to Five minutes |
| Patient Comfort | Patient comfort level measured on a 1-5 Likert Scale | Up to 5 minutes |