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Rethinking Volume Status in Normal Pregnancy versus Preeclampsia
Abstract Number: SAT-45
Abstract Type: Original Research
Objective: Women with preeclampsia (PEC) are thought to be intravascularly depleted from endothelial dysfunction and subsequent third spacing, which is supported by limited data from invasive intracardiac pressure measurements. Echocardiographic (ECHO) assessment of the right heart offers a noninvasive estimate of intravascular volume status. Therefore, we sought to determine if ECHO findings were consistent with decreased intravascular volume in those with PEC.
Study Design: We performed a prospective case control in singleton pregnancies > 23 weeks. Cases included women with PEC with severe features (PEC-SF) or superimposed PEC on preexisting hypertension (SI-PEC) based on ACOG Hypertension in Pregnancy, 2013 guidelines. We excluded those with known valvular malformations, previous cardiac surgery, known pulmonary hypertension, history of pulmonary embolism, or interstitial lung disease. Normotensive controls were recruited from the outpatient setting. Group comparisons were performed using t-tests and ANOVA (STATA, version 13). The sample size is adequate to detect a between-group difference at a p < 0.05 with 80% power.
Results: We recruited 41 women with PEC-SF, 15 with SI-PEC, and 24 controls. Demographic parameters were similar between groups (Table 1). There were no significant ECHO differences in surrogate markers of intravascular volume status in women with PEC-SF, SI-PEC, and normal controls (Table 2).
Conclusion: Although women with PEC are presumed to have a lower intravascular volume, our ECHO data suggests that women with PEC-SF or SI-PEC are not more intravascularly volume depleted than normal pregnant women. Larger cohorts with noninvasive measurements are needed to further assess surrogate markers of volume in both normal pregnancy and PEC patients, which could guide fluid management strategies in these populations.