Transthoracic echocardiography in women with preeclampsia

Recent literature on the role of transthoracic echocardiography in the management of women with preeclampsia is reviewed with emphasis on recommendations for its use in the life-threatening complications of acute pulmonary edema, chest pain, and hemorrhage.

The diagnostic criteria for preeclampsia are closer to reaching international consensus with most guidelines now removing the mandatory requirement for proteinuria. Hemodynamic findings using transthoracic echocardiography in women with untreated preeclampsia include normal or increased cardiac output, normal or increased contractility, a nondilated left ventricle, diastolic dysfunction, increased pericardial effusions, and increased left ventricular mass. Echocardiography is recommended as a diagnostic and monitoring tool for acute hemodynamic complications of preeclampsia, such as acute pulmonary edema, significant arterial hypertension, and chest pain. Despite this there has been limited uptake of transthoracic electrocardiography into routine clinical practice in women with preeclampsia.

The role of transthoracic echocardiography in the management of women with preeclampsia is emphasized by international groups. Research into the hemodynamics in preeclampsia, which demonstrates preserved ejection fraction, and diastolic dysfunction highlights its utility and acceptability by pregnant women with preeclampsia. Training of obstetric anesthesiologists in echocardiography is necessary to enable more widespread implementation of this important technology.