Hemodynamics of Preeclampsia

doi:10.1016/S0095-5108(18)30493-7

Clinics in Perinatology

Volume 18, Issue 4, December 1991, Pages 727-747

https://doi.org/10.1016/S0095-5108(18)30493-7 Get rights and content

The cardiovascular hemodynamics of preeclampsia have been investigated with the use of multiple noninvasive and invasive techniques. The reported findings have ranged from a high cardiac out- put-low resistance state to a low-cardiac output-high resistance state. In addition, pulmonary capillary wedge pressure has been reported to be low, normal, or elevated. Consequently, the recommended management for these patients has been highly variable and controversial, particularly as it relates to vasodilator therapy and plasma volume expansion.

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Cited by (32)

Biomarkers of endothelial dysfunction in preeclampsia and neonatal morbidity: A case-control study
2014, European Journal of Obstetrics and Gynecology and Reproductive Biology
Citation Excerpt :
Levine et al. reported that increased sFlt1 coincides with a decrease in PlGF in the serum of patients with preeclampsia and this results in endothelial dysfunction [29]. Preeclampsia is characterized by generalized endothelial dysfunction manifested by intense vasoconstriction, plasma volume reduction due to capillary leakage and redistribution of the total extracellular fluid volume from the intravascular to the interstitial compartments, constrictor responsiveness and dilator function compromise [30–32]. According to our results, higher concentrations of sFlt-1 were strongly correlated with adverse neonatal outcomes such as late preterm and early term births, as well as VLBW.
To investigate the association of preeclampsia with angiogenic imbalance, and the correlation of levels of angiogenic and anti-angiogenic factors to complications in mother and fetus.
Serum samples were obtained from 40 women with established preeclampsia (study group) and from 40 normotensive women (control group). Epidemiological characteristics of the two groups were analyzed. The levels of the angiogenic (VEGF and PlGF) and anti-angiogenic (sFlt-1) factors of the two study groups were determined in serum using ELISA. Neonatal adverse outcomes (late preterm, early term, low birth weight (LBW), very LBW (VLBW), intrauterine growth restriction (IUGR), and neonatal intensive care unit (NICU) admission) between the groups of the study were analyzed, as well as the association between the biomarkers of the study and neonatal adverse outcomes of the preeclamptic group of patients.
sFlt-1 levels were significantly higher in the preeclamptic women compared to normotensive women (median (range): 21 297 (690–32 637) pg/ml vs. 846.45 (363–2867) pg/ml, respectively), whereas there was a significant decrease in the levels of VEGF (90 (90–211) pg/ml vs. 90.55 (90–521) pg/ml, respectively), as well as in the levels of PlGF (13.62 (8–532) pg/ml vs. 239.86 (61–685) pg/ml, respectively). The increased serum values of the anti-angiogenic sFlt-1 were associated with increased rates of late preterm and early term births and VLBW.
An imbalance between angiogenic and anti-angiogenic factors exists in preeclampsia and is associated with adverse maternal and neonatal outcomes.
Early postpartum management of patients with severe preeclampsia
2010, Annales Francaises d'Anesthesie et de Reanimation
L’accouchement et la délivrance demeurent le traitement de la prééclampsie et permettent dans la majorité des cas la régression spontanée, complète et rapide des signes cliniques et des anomalies biologiques lors des premiers jours du post-partum. Cependant, les risques de complications liées à l’évolution de la maladie persistent principalement dans les 48 à 72 h, parfois jusqu’à une semaine après l’accouchement. Ils sont favorisés par les bouleversements hémodynamiques du post-partum ou les thérapeutiques instaurées. Cette période à risque mérite donc une surveillance intensive et l’adjonction de traitements appropriés.
The delivery of the foetus and placenta remains the curative treatment for PE, usually allowing a spontaneous, quick and complete regression of all clinical signs and biological anomalies within the first days. However, the risk of developing complications associated with the condition persists mainly during the first 48 to 72 hours and up to one week post partum. Post partum haemodynamic upset and the administered therapeutic measures are predisposing factors to these complications. This critical period therefore requires intensive monitoring and the delivery of appropriate treatments.
Role of Echocardiography in the Diagnosis and Management of Heart Disease in Pregnancy
2008, Practice of Clinical Echocardiography, Thrid Edition
Oncotic Therapy in Management of Preeclampsia
2006, Archives of Medical Research
Citation Excerpt :
Intravasal administration of colloid solutions increases intravasal colloid-osmotic pressure and binds water in the intravascular space, thus leading to hypervolemic hemodilution. Hypovolemia/hemoconcentration with oliguria and central venous pressure (CVP) <4 cm H2O is an indication for oncotic therapy to achieve a target CVP of 4–8 cm H2O (4,9,18). Dextran 40,000 and 70,000, 6 and 10% HAES, 3% gelatin, and 5% albumin are used as oncotics.
We undertook this study to examine the effects of oncotic therapy for preeclampsia (PE).
The study included 29 pregnant women with PE and 14 pregnant women with PE and intrauterine growth retardation (IUGR) and hematocrit (Htc) concentration >0.38. All study women received regular antihypertensive therapy and oncotic therapy (dextran 40 or hydroxyethyl starch). The parameters of Htc, uric acid, fibrinogen and platelet count, sonography RI (resistance index) of uterine artery, umbilical artery, middle cerebral artery and fetal biophysical profile were monitored before and after oncotic therapy. Perinatal outcome assessment was based on 5-min Apgar score, umbilical pH, need of neonatal intensive care unit (NICU) treatment, and birth weight.
Statistically significant improvement of hemorheological parameters upon the introduction of oncotic therapy was recorded in the values of Htc, fibrinogen and diastolic blood pressure, whereas other parameters (uric acid, platelet count, uterine arterial RI on the side of placentation, and systolic blood pressure) showed a decrease that did not reach statistical significance. Upon the introduction of oncotic therapy, favorable changes in perinatal Doppler ultrasonography parameters were recorded in uterine arterial RI but not in middle cerebral artery RI. There was no statistically significant change in the fetal biophysical profile (FBP) values either. Perinatal outcome was favorable with a mean 5-min Apgar score 8 and pH 7.26. Lower birth weight values (mean 2631 ± 407 g) were consequential to preterm delivery and IUGR, resulting in a number of neonates requiring NICU treatment.
Careful oncotic treatment with antihypertensive therapy improves the maternal hemorheological parameters and uteroplacental sonographic parameters.
Preeclampsia complicated by placental abruption, HELLP, coagulopathy and renal failure - Further lessons
2003, International Journal of Obstetric Anesthesia
We present a case of preeclampsia complicated by HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome and marked coagulopathy. The severity of the coagulopathy and haemolysis made renal failure and pulmonary oedema inevitable. We identified a number of discussion points in this case. These were the delay to appreciate the haemolysis, the severity of the haemolysis and its interaction with the treatment of coagulopathy and the conservative management of pulmonary oedema. At these points there were shortcomings in our management of this complex case that merit further discussion.
Fluid management in pre-eclampsia
1999, International Journal of Obstetric Anesthesia
We review the evidence base for fluid management in pre-eclampsia. Current understanding of the relevant pathophysiology and the possible impact of styles of fluid management on maternal and fetal outcome are presented. There is little evidence upon which to base the management of fluid balance in pre-eclampsia. Reports are conflicting and no large prospective outcome studies of fluid management have been performed. Volume expansion does not appear to reduce the incidence of fetal distress. Pulmonary oedema and oliguria receive particular attention. There is no evidence of long-term renal damage in pre-eclampsia, but there are strong suggestions that pulmonary oedema is linked to fluid administration. Monitoring is discussed and some principles of management are suggested

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