Postpartum Maternal Echocardiography and Its Effect on Hospital Management in Patients With Severe Preeclampsia [ID: 1378829

Abstract

INTRODUCTION: Maternal echocardiography has demonstrated cardiac changes in the setting of preeclampsia; however, its effect on hospital management has not been well studied. The objective of this study was therefore to determine whether abnormal postpartum echocardiography is associated with a change in hospital management in patients with severe preeclampsia. METHODS: This was a retrospective cohort study of patients with severe preeclampsia (20–42 weeks) who received postpartum echocardiogram before discharge at a single academic institution from 2019 to 2021. The decision to obtain an echocardiogram was made by the primary physician. Patients with clinical indications for echocardiography (suspicion of heart failure and cardiomyopathy) were excluded. Hospital management outcomes included length of hospital stay, diuretic use, increasing antihypertensives, hospital readmission, and cardiology consultation. Patients with normal versus abnormal echocardiograms were compared using the chi-square test or Fisher’s exact test for categorical data and the two-sample t test or Mann-Whitney test for continuous data, with a value of P<.05 considered significant. RESULTS: One hundred forty five patients with preeclampsia who received maternal echocardiograms were included. Twenty-one (14%) had an abnormal echocardiogram, including left ventricle hypertrophy (n=9, 6%), pulmonary hypertension (n=5, 3.4%), moderate pericardial effusion (n=4, 2.7%), and enlarged atrial size (n=3, 2%). Patients with abnormal maternal echocardiograms were more likely to have a longer hospital stay (median stay of 7 days [5, 10] versus 5 days [4, 6], P=.003) and were more likely to receive diuretics (19.1% versus 4%, P=.03). There was no difference in adjustment of antihypertensives (61.9% versus 49.2%, P=.3), cardiology consultation (9.5% versus 6.5%, P=.6), or hospital readmission (4.8% versus 6.5%, P=1). CONCLUSION: Abnormal echocardiograms were associated with change in hospital management including longer hospital stay and more diuretic use. Abnormal postpartum echocardiography may be used to identify patients with more severe disease and adverse clinical outcomes. Further clinical utility of abnormal echocardiograms in severe preeclampsia should be evaluated.