Ultrasound for determining the cause of shock during pregnancy

Abstract

The case report by Richardson, Bahlool and Knight [1] highlights the need for greater awareness of the value of ultrasound examination of the internal jugular veins in cases of acute shock of unclear aetiology. Their case, which presented with several features of pulmonary embolism in pregnancy, was discovered at emergency Caesarean section to be major haemorrhage secondary to a ruptured splenic artery aneurysm. Ultrasound of the neck veins with the patient in the supine position would have immediately distinguished between the empty flat elipses associated with severe haemorrhage and the large discoid veins associated with right ventricular strain caused by massive pulmonary embolus. The use of ultrasound to determine neck vein filling is particularly appropriate to obstetric patients because an ultrasound machine is always close at hand. This technique was invaluable in managing a case of amniotic fluid embolism at this hospital [2]. Additionally, by performing ultrasonic examination of the neck veins of patients in varying degrees of recumbency, it is possible to categorise central venous filling into one of three groups – empty, normal or full – which has proved of great value in the fluid management of mothers with oliguria due to pre-eclampsia.