Ten women with severe
pre-eclampsia, i.e. a blood pressure greater than or equal to 150/110 mmHg or 140/90 mmHg and
proteinuria greater than 3 g/24 h were, after initial
antihypertensive treatment, centrally monitored with a pulmonary artery
catheter (Swan-Ganz). All had been normotensive in early pregnancy. Mean age was 29 years (range 23-37). Mean gestational age upon admission was 29 weeks (range 23-36) and 7 of the women were nulliparous. Nine of the 10 patients had subjective symptoms, e.g.
headache and/or epigastric
pain. All were considered in need of
intensive care. Two patients were found to have an abnormal coagulation and liver function. All patients had normal serum
creatinine values despite
proteinuria.
Hypertension was treated with
dihydralazine and/or
labetalol. Volume substitution was carried out with plasma and
albumin. The women could be divided into two groups: 5 patients where progress of the disease despite
therapy led to delivery within 24 h, and 5 patients whose diastolic blood pressure could be stabilized around 100 mmHg
after treatment and pregnancy could be prolonged by 5-13 days. Common for all patients was a hyperkinetic circulation with an increased cardiac output despite a variety of central pressures. Invasive monitoring of central pressures with a Swan-Ganz
catheter demonstrated that the clinical status could be stabilized and the
pregnancy prolonged in 5 of the 10 women with severe
pre-eclampsia. The variety of the central hemodynamic values illustrates clearly that treatment has to be individualized regarding
antihypertensive medication, fluids and
diuretics.(ABSTRACT TRUNCATED AT 250 WORDS)