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Point of care ultrasound abnormalities in late onset severe preeclampsia: incidence and association with laboratory abnormalities and delivery outcome
Abstract Number: BP-04
Abstract Type: Original Research
Complications of preeclampsia, including pulmonary and cerebral edema, have been demonstrated by point-of-care ultrasound (POC-US)1,2. Also, novel acid-base (AB) markers have been identified3. Our primary goal was to study the incidence of cardiac dysfunction, interstitial pulmonary edema (iPE) and increased optic nerve sheath diameter (ONSD) in women with late onset severe preeclampsia. Secondary aims were to examine the association with AB abnormalities, BNP and delivery outcomes.
95 women were enrolled in this prospective cohort study. At diagnosis, a POC-US examination of heart, lungs and ONSD was performed. Serum BNP and AB-status was analyzed applying the Stewart approach4. iPE was defined as a bilateral B-line pattern on lung-US, and diastolic dysfunction according to the guidelines of the European Society of Cardiology. ONSD > 5.8 mm was interpreted as raised intracranial pressure (ICP) (>20 cmH2O). The association of US-abnormalities with laboratory parameters and delivery outcomes was analyzed.
iPE, diastolic-, systolic dysfunction, and raised LVEDP were present in 23 (24.2%,) 31 (32.6%), 9 (9.5%), and 18 (19.0%) of women respectively(Table 1). ONSD was increased in 27 (28.4%) women. Thirty-nine women (41.0%) had zero-, 34 (35.8%) had 1-, and 22 (23.2%) had ≥2 US abnormalities. Elevated BNP was associated with iPE, raised LVEDP, systolic- and diastolic dysfunction (p<0.0001). AB-analysis revealed hyperchloremic acidosis offset by hypoalbuminemic alkalosis, associated with increased LVEDP (p=0.03). On univariate analysis, iPE was associated with presence of diastolic dysfunction (p=0.02) and raised LVEDP (p<0.0001). On multivariate analysis, the development of an abnormal fetal CTG tracing within 48 hr following diagnosis was associated with having 2 or more US-abnormalities (RR 1.8, 95% CI 1.1 – 3.0, p=0.03), increased ONSD (RR 2.53, 95% CI 1.1-6.4, p = 0.05), and serum albumin level (RR 0.93, 95% CI 0.88-0.99, p=0.02).
iPE, diastolic dysfunction and raised ICP are common in severe preeclampsia. Hypoalbuminemic alkalosis and a higher serum BNP are associated with abnormal cardiac and lung-US findings. Many women have multiple US-abnormalities, and 2 or more US-abnormalities are associated with fetal distress. POC-US may be useful in the evaluation of patients with severe preeclampsia.
1.Zielekiewicz L, Anesthesiology 2014
2.Dubost C, Anesthesiology 2012
3.Ortner C, BJA 2014
4.Story D, A&A 2015