The role of Swan-Ganz catheterization in severe pregnancy-induced hypertension.
Swan-Ganz catheterization was performed in 15 postpartum women who presented with severe pregnancy-induced hypertension at a mean gestational age of 31.5 weeks. The mean arterial pressure on presentation was 137.6 torr (range, 116 to 167 torr), and it remained at approximately 115 torr for the next 72 hours. Serial pulmonary capillary wedge pressure, cardiac output, and colloid oncotic pressure were obtained. The mean pulmonary capillary wedge pressure was 9 torr on insertion of the catheter, and it rose to 13 torr by 36 hours. Three patients whose pulmonary capillary wedge pressure was higher than the mean developed pulmonary edema. The mean colloid oncotic pressure was 14.14 torr. We found that hemodynamic monitoring and determinations of colloid oncotic pressure were useful additions to the clinical examination in the postpartum management of patients with severe pregnancy-induced hypertension. Our patients had a broad range of central volume status, cardiac output, and systemic vascular resistance, and the management was tailored accordingly. Although most patients had hyperdynamic pulmonary cardiac function, three developed edema at a lower pulmonary capillary wedge pressure because of decreased colloid oncotic pressure and possibly increased capillary permeability.
D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D006328:Cardiac Catheterization; D002302:Cardiac Output; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000503:physiopathology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000503:physiopathology; D011644:Puerperal Disorders / Q000175:diagnosis*; D011654:Pulmonary Edema / Q000175:diagnosis; D011669:Pulmonary Wedge Pressure; D014655:Vascular Resistance