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

OBJECTIVE: The objective of this research was to study the safety and utili ty of pulmonary artery catheterization in the management of severe preeclam psia 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 inten sive care unit at Groote Schuur Hospital were found to have required placem ent of a pulmonary artery catheter. From this population 100 maternal chart s 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 ev aluation demonstrated that the pulmonary artery catheter was helpful in det ermining management in 93 cases (93%). There was a 4.0% complication rate, which included three venous thromboses and one case of cellulitis. Eleven p atients required dialysis, and 3 women died. The mean (+/-SE) duration of c atheter 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, respec tively. The pulmonary artery catheter measurements of pulmonary artery wedg e pressure and central venous pressure were increased in the cases of pulmo nary edema (21.0 +/- 2.0 mm Hg and 9.6 +/- 1.2 mm Hg, respectively) but wer e 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 subje ctively beneficial in 93 of 100 cases (93%), with an acceptable complicatio n rate (4.0%).