# Evaluation of extravascular lung water and cardiac function by intrapartum bedside ultrasound: full-term preeclampsia vs. healthy controls

## TL;DR

This study uses bedside ultrasound to compare lung water and heart function in women with preeclampsia and healthy controls during and after childbirth.

## Contribution

The study explores hemodynamic changes in full-term preeclampsia using bedside ultrasound, revealing greater increases in lung water and intravascular volume in preeclamptic women.

## Key findings

- EVLW increased postpartum in both groups, but more so in preeclampsia patients.
- Preeclampsia patients had higher LIMP and RIMP values, indicating altered cardiac function.
- Bedside ultrasound can monitor maternal EVLW and cardiac function in real-time for preeclampsia management.

## Abstract

Studies addressing full-term preeclampsia (PE) remain an area awaiting further exploration, and data concerning hemodynamic changes in women with PE during the initial 2 h postpartum remain elusive. This study aimed to observe the changes in extravascular lung water (EVLW), intravascular volume, and cardiac function in full-term PE before and after delivery and to investigate the differences in these parameters between PE patients and healthy women.

This was a prospective, observational study. A total of 16 women were included in the PE group, and 32 were included in the control group. Bedside ultrasound examinations were performed 24 h before delivery, 2 h after delivery, and 24 h after delivery. A semiquantitative assessment of EVLW was conducted via the 28-rib interspace technique to calculate the echo comet score (ECS). The inferior vena cava collapsibility index (IVC-CI), left ventricular ejection fraction, left atrial volume index, left ventricular E/A ratio, e-peak deceleration time, left ventricular index of myocardial performance (LIMP), right ventricular fractional area change, right atrial volume index, right ventricular E/A ratio, and right ventricular index of myocardial performance (RIMP) were calculated.

ECS increased from 24 h before delivery to 2 h after delivery in both groups. From 2 to 24 h postpartum, only the control group presented a decrease in ECS. The ECS in the PE group remained consistently greater than that in the control group (all P < 0.001). The IVC-CI decreased in both groups from 24 h before delivery to 2 h after delivery and increased in both groups from 2 to 24 h postpartum, with the PE group showing a lower IVC-CI than that in the control group at 2 h postpartum (P = 0.048). The LIMPs in the PE group were greater than those in the control group at 24 h before delivery (P = 0.005), and the RIMPs in the PE group were greater than those in the control group at both 24 h before and 24 h after delivery (P < 0.001, P = 0.011).

In this exploratory, hypothesis-generating study, EVLW and intravascular volume increased postpartum, with a greater increase observed in PE women, who also have a higher risk of pulmonary edema and a greater intravascular volume load. Intrapartum bedside ultrasound can be used for real-time monitoring of maternal EVLW, intravascular volume status, and cardiac function, aiding in the monitoring the condition and fluid management of PE patients.