Hemodymnmiac Changes In Severe Pre-eclampsia During Caesarean Section By Transthoracic Echocardiography

Objective:To determine haemodynamic changes in severe pre-eclampisa during caesarean section by transthoracic echocardiography.Methods:1 Fifteen severe pre-eclampisa patients and fifteen healthy pregnancies were included in the study.2 Caesarean section was performed under spinal anaesthesia in all patients.Thereafter,the patients were turned back to the supine position with a wedge pillow under the right hip and a left lateral tilt of 15°~30°to prevent supine hypotension syndrome.3 The hamodynamic parameters were stored and downloaded in the following periods at 6 time points: Baseline(T0),after fluid infusion(T1),after spinal anesthetic administration(T2),after surgery(T3),immediately after delivery of the newborn and the placenta(T4),skin closure(T5).4 Left ventricular end-diastolic volume(LVEDV),left ventricular endsystolic volume(LVESV),heart rate(HR),Cardiac output(CO),stroke volume(SV)and left ventricular ejection fraction(LVEF)were monitored by transthoracic echocardiography(TTE)use Philips Sparq color Doppler ultrasonic instrument.During the procedure,the patients remained in the supine position.A 2-dimensional image was obtained in the apex of four cavity view.Results:MAP,SVR,LVEDV and LVESV of pre-eclampsia patients was significantly increased compared with that of healthy pregnancies at T0 time point,and SV,CO and LVEF of pre-eclampsia patients was significantly decreased compared with that of healthy pregnancies at the same time point.LVEDV,LVESV and LVEF of all patients at T1 time point was significantly increased compared with that at T0 time point.SV and HR of pre-eclampsia patients was increased significantly after fluid infusion(T1),which caused a significant increase in CO,meanwhile only HR and CO was increased in healthy pregnancies.There is significant different between the groups in SV.SVR and MAP of all patients were decreased significantly compared with that at T0 and T1 time point after spinal administration(T2).But LVEDV,LVESV,LVEF and CO was kept stable after spinal administration(T2).LVEDV,LVESV,LVEF and CO of all patients was increased after delivery of newborn and the placenta(T4).SV and HR were increased in healthy pregnancies,but only HR was increased in pre-eclampsia patients at T4 time point,which caused the increase in CO in all patients.All haemodynamics parameter returned to baseline level in healthy pregnancies after operation,whereas SV,CO,HR and LVEF were still lower than the baseline level in pre-eclampsia patients.Conclusions:1 Compared with healthy pregnancies,the baseline of MAP,SVR,LVEDV,LVESV was increased and SV,CO and LVEF was decreased significantly in pre-eclampsia patients.2 In women with pre-eclampsia,inability to increase SV at the moment of delivery may suggest dysfunction of the left ventricle to adapt to volume load caused by delivery and prompts concern for the increased risk of pulmonary oedema.