The safety and utility of pulmonary artery catheterization in severe preeclampsia and eclampsia

Abstract

Objective: The objective of this research was to study the safety and utility of pulmonary artery catheterization in the management of severe preeclampsia and eclampsia. Study Design: In a retrospective chart review from January 1, 1995, through December 31, 1997, a total of 115 patients admitted to the obstetric intensive care unit at Groote Schuur Hospital were found to have required placement of a pulmonary artery catheter. From this population 100 maternal charts were examined for medical and pregnancy history, including indication for pulmonary artery catheter placement, hemodynamic readings, complications, and subsequent management. Results: The initial indications for pulmonary artery catheter placement in cases of severe preeclampsia or eclampsia were renal failure in 53 cases (53%), pulmonary edema in 30 (30%), and eclampsia in 17 (17%). Subjective evaluation demonstrated that the pulmonary artery catheter was helpful in determining management in 93 cases (93%). There was a 4.0% complication rate, which included three venous thromboses and one case of cellulitis. Eleven patients required dialysis, and 3 women died. The mean (±SE) duration of catheter placement was 2.1 ± 0.1 days and the mean (±SE) intensive care unit and hospital stays were 3.4 ± 0.2 days and 11.4 ± 0.8 days, respectively. The pulmonary artery catheter measurements of pulmonary artery wedge pressure and central venous pressure were increased in the cases of pulmonary edema (21.0 ± 2.0 mm Hg and 9.6 ± 1.2 mm Hg, respectively) but were normal in the cases of renal failure and eclampsia. Conclusion: Despite significant maternal morbidity and mortality, pulmonary artery catheter use in cases of severe preeclampsia or eclampsia was subjectively beneficial in 93 of 100 cases (93%), with an acceptable complication rate (4.0%). (Am J Obstet Gynecol 2000;182:1397-403.)