Bedside lung ultrasound can help detect alveolar lung disease in women with pre-eclampsia, according to a study presented here at the 2018 Annual Meeting of the American Society of Anesthesiologists (ASA).
“Ultrasound is a routinely performed test by doctors to know about the status of unborn babies such as weight, growth, heart rate, and importantly, congenital malformations,” said Kajal Jain, MD, Post Graduate Institute of Medical Education & Research, Chandigarh, India. “The same ultrasound probe if extended a few centimetres higher to scan a the thorax of women with pre-eclampsia could pick up a serious issue like lung congestion. This condition, if not treated timely, can result in an adverse outcome both for the mother and her baby.”
Acute pulmonary oedema has an incidence rate of 1.7% to 2.9% in women with severe pre-eclampsia and can lead to significant increases in patient morbidity and mortality.
A recent study found that bedside lung ultrasound identifies lung interstitial oedema even prior to severe deterioration of arterial oxygenation. In that prospective cohort study, conducted in a level-3 maternity ward during a 12-month period, 20 consecutive women in labour had both lung and cardiac ultrasound examinations performed before and after delivery. Lung ultrasound detected interstitial oedema in 5 patients (25%) with severe pre-eclampsia.
For the current prospective observational study, Dr. Jain and colleagues assessed the ability of bedside lung ultrasound to detect interstitial alveolar syndrome in 70 women with pre-eclampsia with severe features requiring admission due to increased blood pressure readings.
All patients had bedside lung ultrasound and 2D-echocardiography administered on admission to the labour room. A second lung scan was performed immediately following delivery and again within 24 hours following delivery. The researchers looked for “B” lines arising from the lung wall interface.
Of the patients, 64.3% showed significant B lines and 47.14% showed diastolic dysfunction on echocardiography at admission. The incidence of B lines was 65.7% before delivery and 58.6% after delivery.
B-lines correlated with how fast blood pressure increased. Also, a significantly higher number of patients with presence of B-lines on lung sonography complained of breathlessness (P = .007) and had facial puffiness (P = .001).
The researchers said that a larger study in women of different ethnicities is warranted.