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LUNG ULTRASOUND PATTERNS IN PARTURIENTS UNDERGOING VAGINAL AND CESAREAN DELIVERY
Abstract Number: T2C-220
Abstract Type: Original Research
BACKROUND: Lung ultrasound (LUS) is a highly sensitive tool for detecting increased extravascular lung water (EVLW) and diagnosing pulmonary interstitial syndrome (PIS), which precede the development of pulmonary edema (Lichtenstein et al. 2004; Gargani et al. 2007). In healthy term parturients, a recent observational study found LUS patterns comparable to that of non-pregnant patients, however, it is unknown if PIS develops after the processes of labor and vaginal or cesarean delivery (Arbeid et al. 2017). The aim of this study was to determine the prevalence of PIS in healthy term parturients undergoing vaginal, elective and unplanned intrapartum cesarean deliveries.
METHODS: A prospective cohort study (IRB #39605) at an academic hospital with an epidural rate of 83% and a cesarean delivery rate of 32%. We enrolled healthy (ASA status ≤2) term (≥37 weeks gestation) women undergoing vaginal (VD), planned elective CD (eCD) or unplanned (failure to progress, arrest of descent, and/or fetal intolerance of labor) intrapartum CD (uCD). Applying an eight-region technique, LUS was performed within four hours of delivery. PIS was defined as ≥2 positive lung regions per hemithorax, with a positive lung region defined as the presence of ≥3 B-lines per image. All scans were performed by a single examiner and reviewed by two independent, blinded observers.
RESULTS: After screening 108 parturients, LUS was performed in 75 women (n=25 per group). No PIS (0/25; 0%, 95%CI 0-12%) was found in the VD and eCD groups, but in 2/25 (8%, 95%CI 1-26%) women following uCD (P=0.324, Fisher’s exact test). PIS correlated clinically with the development of pulmonary edema in one woman in the uCD cohort. ≥1 positive lung regions were present in 5/25 (20%), 6/25 (24%), and 12/25 (48%) women following VD, eCD, and uCD, respectively, (P=0.067, Chi-Square test; Figure 1). Mean number of positive lung regions was 1.1±1.8 in uCD cohort and 0.4±0.8 in the other two groups (P=0.049, Poisson regression; Figure 1).
CONCLUSIONS: Although many focal areas of increased EVLW (20-48% prevalence) can be identified on LUS, the prevalence of PIS is low among healthy term parturients immediately after delivery. Findings suggest CD compared to VD does not increase the likelihood of developing signs of increased EVLW on LUS, however CD following labor may, and factors for this observation are being further explored.
Lichtenstein, Anesthesiology 2004
Gargani, CCM 2007
Arbeid, GynObsInv 2017