Hypovolemia in toxemia of pregnancy: Plasma expander therapy with surveillance of central venous pressure

Simultaneous investigations of maternal cardiac output and fetal blood flow during hypervolemic hemodilution in preeclampsia — preliminary observations

“…For the compensation of plasma volume deficit and to restitute blood fluidity the therapeutic use of plasma volume expanders (f. e. low molecular dextran) is recommended. Several groups (GooDLiN et al [6], CLOEREN et al [4], HEILMANN et al [9], SEGHAL et al [20], SCHRÖCK [18]) have demonstrated benefitial effects on fetal status and development in the course of hypervolemic hemodilution in preeclampsia. This therapeutic procedure presumes the continuous surveillance of maternal hemodynamics to early recognize heart insufficiency or fluid overload in the lungs.…”

“…In contrast, JOUPPILA et al [12] estimated no improvement of placental perfusion in the course of a 100 ml infusion of 20% human albumin. For the early detection of heart decompensation attributed to fluid overload during plasma expander therapy intensive surveillance is recommended [4]. In previous studies [22] we could demonstrate that alterations in maternal cardiac output as well as the fluid intake in the lungs can be continuously monitored by means of noninvasive thoracic impedance cardiography.…”

“…Since the occurrence of plasma volume depletion represents a typical pathophysiological feature in preeclampsia [5,7,10], several groups have demonstrated favorable results in the treatment with plasma volume expanders [4,6,8,9,18,19,20,22]. During hypervolemic hemodilution with low molecular dextran, both SCHWARZ and RETZKE [19] and CLOEREN et al [4] described increased impulse rates using isotope techniques as an index of elevated placental perfusion.…”

“…During hypervolemic hemodilution with low molecular dextran, both SCHWARZ and RETZKE [19] and CLOEREN et al [4] described increased impulse rates using isotope techniques as an index of elevated placental perfusion. In contrast, JOUPPILA et al [12] estimated no improvement of placental perfusion in the course of a 100 ml infusion of 20% human albumin.…”

Salt, Diuretics and Pregnancy

“…This is one explanation why the birth weight in pre-eclampsia is often lower than expected in relation to the length of gestation. According to some authors the administration of plasma expanders, such as albumin, increases the circulating blood volume and improves the placental blood flow (9). This opinion concerning the significance of hypovolemia has recently been lively criticized by Assali and Vaughn (3).…”