In about 20% of preeclamptic patients, ONSD reaches values compatible with intracranial pressure above 20 mmHg. Further work is needed to confirm this incidence and to better understand the diagnostic and therapeutic usefulness of this easy-to-do monitoring technique.

P reeclampsia/eclampsia is a well-known and potentially severe disease with dire complications. In some patients with eclampsia, computed tomography and magnetic resonance imaging studies have shown signs of raised intracranial pressure (ICP), but the actual incidence of raised ICP in preeclampsia is unknown. Clinical studies have also indicated that ultrasonographic measurements of the optic nerve sheath diameter (ONSD) correlate with signs of raised ICP, which may mean that ONSD could be a reliable noninvasive surrogate marker of raised ICP. This descriptive study was undertaken to estimate and evaluate the incidence of raised ICP in preeclampsia using ocular ultrasonography with ONSD measurement based on the hypothesis that patients with preeclampsia would have higher ICP than healthy pregnant patients at delivery.Patients with mild or severe preeclampsia and healthy pregnant women underwent ultrasound measurement of ONSD in the supine position, with the upper body and head at 30 degrees above the horizontal position. A thick layer of gel was applied over the closed upper eyelid, and a linear probe was placed on the temporal area of the eyelid. The entry of the optic nerve into the globe was displayed, and the field was reduced to a 4-cm depth. Optic nerve sheath diameter was measured 3 mm behind the globe; 4 measurements were obtained, 1 each in the transverse and sagittal plane for each eye. Based on literature reports, an ONSD value greater than 5.8 mm carries a 95% risk of raised ICP.Thirteen patients had mild, and 13 had severe preeclampsia and were compared with 25 healthy pregnant women. The 2 groups were similar in demographic characteristics, including weeks of gestation at the time of ocular examination, numbers of gestations, and parity. At admission, the systolic, mean, and diastolic arterial pressures were substantially higher in the preeclamptic group compared with the healthy controls (143 vs 111 mm Hg, 105 vs 84 mm Hg, and 84 vs 70 mm Hg, respectively). Five of the 26 preeclamptic patients (19%) had ONSD values greater than 5.8 mm compared with none of the healthy group. Median baseline ONSD in preeclamptic patients was 5.4 versus 4.5 mm in the healthy women. A decrease in ONSD was seen after the third postpartum day in the preeclamptic women; values on day 7 were not different from those in healthy women. By day 7, all preeclamptic patients had an improved clinical and biologic profile. In a second control group of healthy pregnant patients studied in the time around delivery, ONSD values did not have changes within this period, specifically 4.9 and 4.8 mm before and after delivery, respectively. Optic nerve sheath diameter did not differ in patients with mild and severe preeclampsia. In a subgroup of 4 patients with criteria for hemolysis, increased liver enzymes, and low platelet counts, ONSD values were not different.For È20% of patients with preeclampsia, ONSD reaches values compatible with ICP greater than 20 mm Hg. This noninvasive estimate of the incidence of raised ICP may be useful to...

Background Fetal radiation exposure in pregnant women with trauma is a concern. The purpose of this study was to evaluate fetal radiation exposure with regard to the type of injury assessment performed. Methods It is a multicentre observational study. The cohort study included all pregnant women suspected of severe traumatic injury in the participating centres of a national trauma research network. The primary outcome was the cumulative radiation dose (mGy) received by the fetus with respect to the type of injury assessment initiated by the physician in charge of the pregnant patient. Secondary outcomes were maternal and fetal morbi-mortality, the incidence of haemorrhagic shock and the physicians’ imaging assessment with consideration of their medical specialty. Results Fifty-four pregnant women were admitted for potential major trauma between September 2011 and December 2019 in the 21 participating centres. The median gestational age was 22 weeks [12–30]. 78% of women (n = 42) underwent WBCT. The remaining patients underwent radiographs, ultrasound or selective CT scans based on clinical examination. The median fetal radiation doses were 38 mGy [23–63] and 0 mGy [0–1]. Maternal mortality (6%) was lower than fetal mortality (17%). Two women (out of 3 maternal deaths) and 7 fetuses (out of 9 fetal deaths) died within the first 24 h following trauma. Conclusions Immediate WBCT for initial injury assessment in pregnant women with trauma was associated with a fetal radiation dose below the 100 mGy threshold. Among the selected population with either a stable status with a moderate and nonthreatening injury pattern or isolated penetrating trauma, a selective strategy seemed safe in experienced centres.

In Reply:We thank Drs. Palte and Gayer for their thoughtful response to our recently published article. 1 We appreciate their input and would like to respond to their comments.Patient's safety in anesthesiology is a critical point and becomes even more important in the context of medical research. We totally agree that ocular sonography can be detrimental by either thermal or mechanical injuries. Palte et al., 2 in an animal study on four rabbits, have clearly demonstrated that significant increase in ocular temperature (more than 1.5°C) may occur in subcutaneous, corneal, cameral, or vitreal areas after 90 s of direct application to the cornea of a Micromaxx® 10 MHz probe (Sonosite, Bothell, WA); the latter been used in our study. They have also shown that this thermal effect is time dependent. In our study, two trained investigators made all measurements, and strict attention was paid to decrease exposure time to ultrasound to less than 60 s. As has recently been highlighted, 3 "minimizing the exposure time is probably the most important factor for ensuring patient safety from thermal injury." Moreover, in our study, applying the probe on a thick layer of ultrasound gel over the closed upper eyelid could have decreased the heat transfer.Anesthesiologists who want to train for ocular ultrasonography should, however, be aware of the risk of prolonged exposure to ultrasounds. In the view of current knowledge in the topic, limiting the examination time to less than 90 s seems to be safe. It would be of great interest to develop ocular phantoms modelizing the eye and optic nerve sheath to allow training in ocular ultrasound without unnecessary human exposure to ultrasound. We also strongly encourage manufacturers to develop specific ocular settings or dedicated probes for ocular ultrasonography with low power output and mechanical and thermal indexes less than 1, allowing nonspecialists in ocular sonography to study in full safety the incidence of raised intracranial pressure in pathologies as preeclampsia or others.