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Feasibility of the Focused Rapid Echocardiographic Examination in Parturients
Abstract Number: F-28
Abstract Type: Original Research
Background: This is original research designed to test the feasibility of a Focused Rapid Echocardiographic Examination (FREE) in parturient patients. The FREE was previously used at the University of Maryland to assess volume status, overall cardiac function, and answer clinical questions of care for critically ill patients. This echocardiogram is a modified version of a traditional transthoracic echocardiogram involving four views designed to produce information regarding global cardiac function, volume status, volume responsiveness, stroke volume and cardiac output, and basic valvular function which can then be used to make real time clinical decisions that impact patient care. The FREE has been demonstrated to change care in the critically ill.(1) It is our hypothesis that this exam can be applied to parturients with the hope that it will ultimately assist in their care.
Methods: Study participants were term gravida admitted to Labor and Delivery for labor, induction of labor, or cesarean section. Informed consent was obtained and a FREE was completed on all subjects before delivery and within 24 hours after delivery. Four standard transthoracic views were obtained on 10 patients: 1) parasternal long axis, 2) parasternal short axis, 3) apical four/five chamber and 4) subxyphoid. Patients were in the supine position during the examination with left uterine displacement.
Results: We were able to successfully obtain all four views mentioned above on all 10 patients. We were able to calculate stroke volume, cardiac output and systemic vascular resistance in the majority of the patients. Assessment of systolic and diastolic function was made and the aortic, mitral, and tricuspid valves were evaluated. Estimates of volume status were made based on the LV internal dimension and stroke volume variation measurements. All patients had small or partially to fully collapsed IVC.
Conclusion: Cardiac disease now encompasses a large proportion of maternal mortality in the developed world. At our institution, we care for a large number of high-risk obstetric patients with both obstetrical disorders as well as comorbidities that may impact cardiac function and anesthetic management. Some of which include obesity, pre-existing cardiac dysfunction or abnormalities, hypertension and diabetes. It is our hope that the application of this study to parturients, if proven feasible, can assist in real-time clinical decision-making and will impact patient care, reducing maternal mortality from cardiac disease.
1. Ferrada P, et al. J of Trauma. 70: 2011.