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The use of transthoracic echocardiography to quantify hemodynamics in women with severe preeclampsia
Abstract Number: F-65
Abstract Type: Original Research
Introduction: Preeclampsia (PE) has debilitating cardiovascular consequences & is a significant global health burden. Severe hypertension should be treated, but amongst the safe antihypertensive agents, none is clearly superior.1 There is often clinical uncertainty as to correct fluid therapy in severe PE. Transthoracic echocardiography (TTE) is used as an initial investigation to assess hemodynamics including volume status, in non-pregnant women with malignant hypertension, but is not commonly used when managing pregnant women with PE.2 This study aimed to assess the feasibility & value of emergency TTE, & to quantify the range of hemodynamic variables in severe PE, in a large maternity hospital in South Africa.
Method: Over a 2 week period, 20 women with PE (systolic blood pressure (BP) ≥ 160 mmHg +/- diastolic BP ≥ 110 mmHg & proteinuria), requiring immediate treatment, underwent TTE during or immediately after acute treatment.
Results: Hemodynamic assessment was possible in all women (Table 1). Four (20%) women had eclampsia, one was intubated; one (5%) woman was in pulmonary oedema; nine (45%) had cerebral symptoms with either a severe headache/visual disturbance without eclampsia.
Conclusion: The majority of women with severe PE were in the third trimester of their second or subsequent pregnancy. Many were critically ill. Systolic & diastolic BP remained significantly elevated during & after initial treatment in most women. The left ventricle (LV) was not dilated & there was preservation of systolic function in all women, except in the patient in pulmonary edema, whose BP was critically elevated. Subclinical myocardial systolic impairment & the presence of a biphasic s′ velocity waveform were present in the majority of women. Diastolic dysfunction was common. Structural changes included pericardial effusions & increased LV mass in most women. TTE was feasible at the time of life-threatening complications of PE. There was a wide range of values of hemodynamic variables in this cohort, & TTE could be used to assess individual women with PE. In severe cases, treatment interventions such as antihypertensive agents & fluid therapy should be guided by these hemodynamic findings.
1 Duley L, Meher S, Jones L. Drugs for treatment of very high blood pressure during pregnancy. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD001449. DOI: 10.1002/14651858.CD001449.pub3
2 Dennis AT. IJOA; 2011;20:160-8.