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Perioperative hemodynamics in women with early- and late-onset preeclampsia
Abstract Number: O1-03
Abstract Type: Original Research
Background: The aim of this study was to describe hemodynamic changes pre-delivery and during spinal anaesthesia for cesarean delivery, in women with severe preeclampsia (PE), and to compare findings in early- versus late-onset severe disease.
Methods: A total of 68 women with severe PE were included in this observational study, conducted at the High Risk Referral Unit of Oslo University Hospital, Rikshospitalet, Norway. All patients had beat by beat arterial blood pressure and cardiac output (CO) monitoring with the LiDCOplus monitor.
Results: Thirty-six patients scheduled for cesarean delivery (CD) for worsening maternal disease had hemodynamic monitoring during spinal anesthesia (SA), 21 with early-onset- (GA<34 weeks), and 15 with late-onset disease (GA>34 weeks). There were no between-group differences in blood pressure predelivery (mean arterial pressure 138- versus 137 mmHg). Magnesium sulphate was administered to 15/21 (71.4%) in the early-onset group and 8/15 (53%) in the late-onset group. Antihypertensive treatment was given to all except 3 (14.3%) and 5 (33.3%) patients in the early-onset and late-onset groups respectively. The early-onset patients had a higher hemoglobin/hematocrit pre-delivery (13.1 vs 12.2 g/dl, p=0.022), higher systemic vascular resistance (SVR) (1850 vs 1377 dyne.s.cm-5, p=0.006), and lower CO (6.0 vs 7.8 l/min, p=0.002), compared to the late-onset group. These patients received higher doses of spinal bupivacaine (11.3 mg) than the late-onset group (9.9 mg). Following induction of SA, both groups had similar minor hemodynamic changes in blood pressure, SVR, and CO. There were no between-group differences in the volume of fluids or vasopressor dose administered. The mean birth weight was 1362- and 2683 g in the early- and late onset groups respectively. APGAR score was statistically significantly lower (p=0.028), and there were 4 fetal deaths in the early-onset group.
Conclusions: These observational data suggest that in patients with severe PE presenting for CD with equivalent degrees of hypertension, SVR is higher and CO lower in early-onset- compared with late-onset PE. Changes in CO, SVR, and blood pressure in responses to SA were similar and minor in the majority of patients in both groups even though the early-onset group had higher doses of spinal bupivacaine.
Valensise H. et al. Early and late preeclampsia.Two different maternal hemodynamic states in the latent phase of the disease. Hypertension 2008;52:873 ̶ 880.