Point-of-care lung ultrasound patterns in late third-trimester gravidas with and without preeclampsia

Shetty, Sarah L. Pachtman; Koenig, Seth; Tenenbaum, Sara; Meirowitz, Natalie

doi:10.1016/j.ajogmf.2021.100310

Cited by 11 publications

(39 citation statements)

References 35 publications

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“…Seven full-text articles were eventually included as per the selection criteria. [ 5 8 9 10 12 13 14 ]…”

Section: Resultsmentioning

confidence: 99%

“…[ 5 13 ] In one study, only LUS was done. [ 14 ] For LUS, 28 rib interspace technique was used in two studies,[ 12 13 ] eight region technique in two studies,[ 8 9 ] four region technique devised from eight region technique in one study[ 14 ] and 12 region technique was used in another study. [ 10 ] The US imaging and interpretation of images was done by either a certified operator/cardiologist/obstetrician/registered medical sonographer/echocardiography investigator/pulmonary expert.…”

Section: Resultsmentioning

confidence: 99%

“…[ 15 ] Healthy parturients were included as controls in three studies. [ 9 12 14 ] Late-onset SPE cases (>34 weeks gestation) were included in the study by Ortner et al ., whereas thosebeyond 20 weeks of gestation and in first stage of labour were included in the study by Hammad et al . Clinical symptoms of pulmonary oedema were looked for in four studies.…”

Section: Resultsmentioning

confidence: 99%

“…[ 10 ] In four studies, magnesium sulphate (MgSO 4 ) prophylaxis with 4 g bolus MgSO 4 loading dose was given followed by 1 g/h (50 mL/h) infusion for 24 h.[ 5 8 13 14 ] There is no mention of fluid management in three studies. [ 9 10 14 ] IV hydralazine, labetalol was given for the acute management of hypertension for a target systolic BP <160 mmHg and diastolic BP <119 mmHg in four studies. [ 5 8 12 13 ]) Arterial oxygen saturation was monitored by pulse oximetry in three studies.…”

Section: Resultsmentioning

confidence: 99%

“…[ 5 8 12 13 ]) Arterial oxygen saturation was monitored by pulse oximetry in three studies. [ 9 10 14 ]…”

Section: Resultsmentioning

confidence: 99%

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Point-of-Care Ultrasound (POCUS) for the assessment of volume status and fluid management in patients with severe pre-eclampsia: A systematic review and meta-analysis

Bajwa¹,

Kurdi²,

Sutagatti³

et al. 2021

Indian Journal of Anaesthesia

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Background and Aims: Appropriate volume assessment and fluid management can prevent maternal deaths in the severely pre-eclamptic (SPE) parturients. We planned a systematic review and meta-analysis (MA) to evaluate the role and ability of point-of-care ultrasound (POCUS) in the assessment of volume status and early detection of lung oedema in an SPE parturient. Methods: An e-literature search was done from several databases. Data were extracted under five domains including POCUS-derived parameters like echo comet score (ECS), lung ultrasound (LUS) scores, B-patterns, optic nerve sheath diameter (ONSD), E/e' ratio, presence of pleural effusion, pulmonary interstitial syndrome and pulmonary congestion. The risk of bias was assessed. Extracted data were analysed using MetaXL and Revman 5.3. Heterogeneity in the studies was evaluated using the Cochrane Q test and I 2 statistics. Funnel plots were used for the assessment of publication bias. Results: Seven prospective studies including 574 parturients (including 396 pre-eclamptics) were selected. POCUS included lung, optic nerve, cardiac and thoracic US. In two studies, the ECS and LUS scores pre-delivery were higher in pre-eclamptics. Two studies found a mean ONSD of 5–5.84 mm before delivery. MA revealed a significantly lower mean ECS score at post-delivery than pre-delivery, and the summary prevalence of B-pattern and pleural effusion among SPE parturients was found to be 0.28 (0.03–0.84) and 0.1 (0–0.2), respectively. A good correlation was observed between B-line patterns and diastolic dysfunction (increased E/e' ratio), LUS score and thoracic fluid content, ONSD and ECS in individual studies. Conclusion: POCUS parameters can be useful as early markers of fluid status and serve as useful tools in the precise clinical management of pre-eclampsia.

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“…Seven full-text articles were eventually included as per the selection criteria. [ 5 8 9 10 12 13 14 ]…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…[ 5 8 12 13 ]) Arterial oxygen saturation was monitored by pulse oximetry in three studies. [ 9 10 14 ]…”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Point-of-Care Ultrasound (POCUS) for the assessment of volume status and fluid management in patients with severe pre-eclampsia: A systematic review and meta-analysis

Bajwa¹,

Kurdi²,

Sutagatti³

et al. 2021

Indian Journal of Anaesthesia

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A Call for Development of Point‐of‐Care Ultrasound Training Recommendations in Obstetrics and Gynecology Residency

Lammers

Dolin

Baston

2021

J of Ultrasound Medicine

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Point‐of‐care ultrasound (POCUS) skillsets are now taught throughout training levels from medical school through fellowship given the broad utility in assisting with bedside procedures and triaging clinical presentations for expedited workup. This is reflected in training curricula for emergency medicine, internal medicine, and general surgery residencies. However, these skillsets are not formally taught or required in obstetrics and gynecology residency. We present the opinion that these skillsets and curricula should be developed for obstetrics and gynecology trainees given their exposure to patients with similar clinical presentations in which the clinical management would be aided by POCUS.

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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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Point-of-care lung ultrasound patterns in late third-trimester gravidas with and without preeclampsia

Cited by 11 publications

References 35 publications

Point-of-Care Ultrasound (POCUS) for the assessment of volume status and fluid management in patients with severe pre-eclampsia: A systematic review and meta-analysis

Point-of-Care Ultrasound (POCUS) for the assessment of volume status and fluid management in patients with severe pre-eclampsia: A systematic review and meta-analysis

A Call for Development of Point‐of‐Care Ultrasound Training Recommendations in Obstetrics and Gynecology Residency

Point‐of‐Care Ultrasound in Critical Care Obstetrics

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