Lung and cardiac ultrasound for hemodynamic monitoring of patients with severe pre‐eclampsia

Ambrožič, Jana; Šimenc, Gabrijela Bržan; Prokšelj, Katja; Tul, Nataša; Cvijić, Marta; Lučovnik, Miha

doi:10.1002/uog.17331

Cited by 49 publications

(83 citation statements)

References 41 publications

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“…These findings have also been confirmed by Ambrozic et al. . Conversely, we described one case with tocolytic‐induced pulmonary oedema, who had normal filling pressures but still had bilateral anterior B‐lines and alteration of the pleural line, suggesting a non‐cardiogenic mechanism .…”

Section: Methodssupporting

confidence: 89%

“…More recently, Ambrozic et al. confirmed these findings; in their cohort only 14% of the women with severe pre‐eclampsia were fluid responsive .…”

Section: Methodsmentioning

confidence: 74%

“…Given the susceptibility of pregnant women to pulmonary oedema, direct evaluation of extravascular lung water may provide additional important information before fluid administration in this population. B‐lines are associated with elevated filling pressures and a low ∆VTI in women with pre‐eclampsia . Therefore, the presence or appearance of bilateral anterior B‐lines should discourage fluid administration in the context of severe pre‐eclampsia.…”

Section: Methodsmentioning

confidence: 99%

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Diagnostic point‐of‐care ultrasound: applications in obstetric anaesthetic management

et al. 2018

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Complications during pregnancy are not frequent, but may occur abruptly. Point-of-care ultrasound is a non-invasive, non-ionising diagnostic tool that is available at the bed-side when complications occur. This review covers the use of ultrasound in various clinical situations. Gastric ultrasound can identify stomach contents that put the woman at risk for pulmonary aspiration. In the future, this tool will probably be used routinely before induction of anaesthesia to determine the presence of stomach contents above a particular risk threshold. Difficult tracheal intubation, and the potential for 'can't intubate, can't oxygenate', is more frequent in pregnant women. Point-of-care ultrasound of the airway allows accurate identification of the cricothyroid membrane, permitting rapid and safer establishment of front-of-neck airway access. Combined cardiac and lung ultrasound can determine the potential risk:benefit of fluid administration in the pregnant patient. Such prediction is of critical importance, given the tendency of pregnant women to develop pulmonary oedema. Combined echocardiography and lung ultrasound can be combined with ultrasound of the leg veins to differentiate between the various causes of acute respiratory failure, and guide treatment in this situation. Finally, as shown in the general population, multi-organ point-of-care ultrasound allows early diagnosis of the main causes of circulatory failure and cardiac arrest at the bed-side. As the importance of point-of-care ultrasound in critical patients is increasingly recognised, it is emerging as an important tool in the therapeutic armoury of obstetric anaesthetists.

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Section: Methodssupporting

confidence: 89%

“…More recently, Ambrozic et al. confirmed these findings; in their cohort only 14% of the women with severe pre‐eclampsia were fluid responsive .…”

Section: Methodsmentioning

confidence: 74%

Section: Methodsmentioning

confidence: 99%

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Diagnostic point‐of‐care ultrasound: applications in obstetric anaesthetic management

et al. 2018

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“…Ambrozic et al evaluated lung and cardiac ultrasound for assessment of fluid tolerance and fluid responsiveness in severely pre‐eclamptic patients before and after delivery. They found that severe PE is associated with an increase in extravascular lung water, which could in part be caused by disturbed diastolic LV function.…”

Section: Introductionmentioning

confidence: 99%

“…Excess lung water can be identified in severely pre‐eclamptic patients before the appearance of clinical signs by using lung ultrasound. The role of these findings in clinical practice still needs to be determined.…”

Section: Introductionmentioning

confidence: 99%

Maternal hemodynamics: a 2017 update

Ghossein‐Doha

Khalil

Lees

2017

Ultrasound in Obstet & Gyne

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Point‐of‐Care Ultrasound in Critical Care Obstetrics

Martins,

Waller,

Horgan

et al. 2024

J of Ultrasound Medicine

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ObjectivesTo synthesize the current evidence of maternal point‐of‐care ultrasound (POCUS) in obstetrics. A scoping review was conducted using PubMed, Clinicaltrials.gov, and the Cochrane library from inception through October 2023.MethodsStudies were eligible for inclusion if they described the use of POCUS among obstetric or postpartum patients. Two authors independently screened all abstracts. Quantitative, qualitative, and mixed‐methods studies were eligible for inclusion. Case reports of single cases, review articles, and expert opinion articles were excluded. Studies describing detailed maternal nonobstetric sonograms or maternal first trimester sonograms to confirm viability and rule out ectopic pregnancy were also excluded. Data were tabulated using Microsoft Excel and summarized using a narrative review and descriptive statistics.ResultsA total of 689 publications were identified through the search strategy and 12 studies met the inclusion criteria. Nine studies evaluated the use of lung POCUS in obstetrics in different clinical scenarios. Lung ultrasound (LUS) findings in preeclampsia showed an excellent ability to detect pulmonary edema (area under the receiver operating characteristic 0.961) and findings were correlated with clinical evidence of respiratory distress (21 of 57 [37%] versus 14 of 109 [13%]; P = .001). Three studies evaluated abdominal POCUS, two of the inferior vena cava (IVC) to predict postspinal anesthesia hypotension (PSAH) and fluid receptivity and one to assess the rate of ascites in patients with preeclampsia. Patients with PSAH had higher IVC collapsibility (area under the curve = 0.950, P < .001) and, in patients with severe preeclampsia, there is a high rate of ascites (52%) associated with increased risk of adverse outcomes. There were no studies on the use of subjective cardiac POCUS.ConclusionPOCUS use in the management of high‐risk obstetrics has increased. LUS has been the most studied modality and appears to have a potential role in the setting of preeclampsia complicated by pulmonary edema. Cardiac and abdominal POCUS have not been well studied. Trials are needed to evaluate its clinical applicability, reliability, and technique standardization before widespread use.

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Lung and cardiac ultrasound for hemodynamic monitoring of patients with severe pre‐eclampsia

Abstract: ABSTRACT

Cited by 49 publications

References 41 publications

Diagnostic point‐of‐care ultrasound: applications in obstetric anaesthetic management

Diagnostic point‐of‐care ultrasound: applications in obstetric anaesthetic management

Maternal hemodynamics: a 2017 update

Point‐of‐Care Ultrasound in Critical Care Obstetrics

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