Fluid management in pre-eclampsia

Engelhardt, Thomas; MacLennan, F. M.

doi:10.1016/s0959-289x(99)80106-x

Cited by 29 publications

(14 citation statements)

References 70 publications

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“…normal saline 20 ml.h )1 ) should suffice. Disparity between CVP and pulmonary artery wedge pressure (PAWP) is a distinct possibility (PAWP may be considerably higher as a result of left ventricular dysfunction) [40]. Administration of blood and blood products seems to be a risk factor for the development of pulmonary oedema [41].…”

Section: Fluid Balancementioning

confidence: 99%

Emergency Caesarean section: best practice*

Levy

2006

Anaesthesia

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Good multidisciplinary communication is crucial to the safe management of women requiring non-elective Caesarean section. Anaesthetists should participate actively in resuscitation of the fetus in utero; relief of aortocaval compression is paramount. Epidural top-up with levobupivacaine 0.5% is the anaesthetic of choice for women who have been receiving labour epidural analgesia. If epidural top-up fails to provide bilateral light touch anaesthesia from S5 -T5, a combined spinalepidural technique with small intrathecal dose of local anaesthetic is a useful approach. Preeclampsia is not a contra-indication to single-shot spinal anaesthesia, which is the technique of choice for most women presenting for Caesarean section without an epidural catheter in situ. Induction and maintenance doses of drugs for general anaesthesia should not be reduced in the belief that the baby will be harmed. Early postoperative observations are geared towards the detection of overt or covert haemorrhage.

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Section: Fluid Balancementioning

confidence: 99%

Emergency Caesarean section: best practice*

Levy

2006

Anaesthesia

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“…Literature reports are conflicting and no large prospective outcome studies of fluid management have been performed 19 .…”

Section: Discussionmentioning

confidence: 99%

“…Engelhard and MacLennan 19 in their review about the fluid management in preeclampsia, stated that 'There is no evidence of long-term renal damage in preeclampsia, but there are strong suggestions that pulmonary oedema is linked to fluid administration. Problems arise with fluid balance if renal insufficiency and injudiciously large fluid loads coexist'.…”

Section: Discussionmentioning

confidence: 99%

The fluid balance observed postnatally on normal pregnancies, pregnancies with preeclampsia, and on pregnancies with oedema and proteinuria

Diamanti¹,

Κatsaounou²,

Vivilaki³

2017

Eur J Midwifery

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in arterial blood pressure and systemic vascular resistance. Mostly, all of these changes are generally reversed in weeks or months after delivery [1][2][3][4][5] . To be more specific, pregnancy is a volume-expanding state characterized by net sodium retention of 900 to 1000 mEq, as well water retention of 1.1 to 1.6 L, mediated by a balance between natriuretic and anti-natriuretic forces 1 . A rise in serum aldosterone is ABSTRACT INTRODUCTION It is observed that delivery does not completely eliminate the risk of developing symptoms of preeclampsia, as well as its impending complications. The postpartum period is often associated with a high risk of developing preeclampsia, eclampsia and HELLP syndrome. Yet, there is neither an established standard, nor specific guidelines for peripartum fluid management. Our purpose is to study during the first four days of the postpartum period the differences in fluid balance on: normal pregnancies, pregnancies with preeclampsia and pregnancies with oedema and proteinuria. METHODS The setting was the Gaia private maternity clinic in Athens, where 100 women in the postpartum period took part in the study and were requested to fill in a data collection-sheet, specially developed for the study. They were recruited between January 2014 and November 2014 and were divided into three groups. Group I consisted of all normal pregnancies, Group II those with oedema and proteinuria, and Group III those with preeclampsia. The demographic and clinical characteristics of the women and fetuses were initially recorded. Subsequently, daily records of fluid balance, as well as body weight, were kept for four days after labor. Descriptive statistics were used to analyze the demographic data of the sampled women. We compared the fluid balances among the three groups using t-test association and one-way Anova. RESULTS The mean age of the women was 32.48±4.38 years. Out of a total of 100 women, 59 of them had a normal pregnancy (Group I), 24 developed oedema and proteinuria (Group II) and 17 developed preeclampsia (Group III). All three groups had a positive fluid balance on the first day postpartum and only the first group had a negative cumulative fluid balance from the second day postpartum and onwards. The second group despite having started to discard a small volume of fluid, from the second day postpartum, the balance remained positive throughout the next two days. The third group however, had a negative fluid balance only during the fourth day after labor. CONCLUSIONS Our results indicate a difference in the kinetics of fluids in women with preeclampsia, compared to those that had a normal pregnancy and postpartum period. Consequently, there appears to be a need for more rational management and follow up on fluid balance throughout labor. INTRODUCTIONPregnancy involves remarkable changes in the anatomy and physiology that affect the renal and the cardiovascular system, in many aspects. These changes are in fact essential for the development and maintenance of a successful pregnancy, both ...

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“…results in impaired utero-placental perfusion 2 . Volume expansion and reduction in blood pressure have been attempted with and without central haemodynamic monitoring.…”

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confidence: 99%

Fluid and Nutritional Management Can Significantly Reduce the Mortality of Patients with Eclampsia in Resource Poor Settings

Begum

Akhter

Uddin

et al. 2016

Bangladesh J Obstet Gynaecol

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Objective: To observe fluid and nutritional management along with specific management and close clinical monitoring without intensive care management improve the condition of unconcious eclamptic patients in the resource poor setting.Method: Six hundred and nine(609) eclamptic patients were admitted in Mymensingh Medical College Hospital from January to December 2008. Twenty four (24) unconscious eclamptic patients were enrolled for this clinical trial study. These patients were managed in eclampsia ward with fluid therapy of 0.9% sodium chloride, 25% glucose, 5% aminoacids along with hydrocortisone and in some cases nasogastric feeding in addition to other regular medications. They were compared with 26 eclampsia patients treated with normal regular hospital management. A systematic guideline was followed and patients were closely monitored until the outcome.Results: The mean age of 23 years, 18 cases were primi-gravida; 16 had intrapartum, 6 had postpartum and 2 had antepartum eclampsia. The mean number of convulsion before admission was 12. The mean Glasgow Coma Scale (GCS) of these patients during admission was 5, which improved to 10.3 in 24 hours and 14.5 in 36 hours. None of these patients had fatal outcome in compare to observation group where three patients died following complications.Conclusion: Close monitoring with fluid and nutritional management can significantly reduce the mortality of unconscious eclamptic patients in resource poor settings where intensive care facility is limited. Development and adaptation of feasible systematic guideline for the management of unconscious eclamptic patient should be scaled up for the resource poor settings of developing and under developed countries.Bangladesh J Obstet Gynaecol, 2012; Vol. 27(1) : 18-20

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Fluid management in pre-eclampsia

Cited by 29 publications

References 70 publications

Emergency Caesarean section: best practice*

Emergency Caesarean section: best practice*

The fluid balance observed postnatally on normal pregnancies, pregnancies with preeclampsia, and on pregnancies with oedema and proteinuria

Fluid and Nutritional Management Can Significantly Reduce the Mortality of Patients with Eclampsia in Resource Poor Settings

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