title: [Role of whole-body ultrasound in severe pre-eclampsia and post-partum hemorrhage].
abstract: OBJECTIVE
  Management of severe pre-eclamptic patients is a challenge for the staff on obstetrical wards. We demonstrate that ultrasound applied to several organs performed at a patient's bedside gave the information required for the patient's management, without the need to transfer her to the radiology department or to call external consultants.
  
  
  METHODS
  A 29-yr-old severely pre-eclamptic patient with HELLP syndrome (hemolysis, cytolysis, thrombopenia) presented, in the post-partum period, with an occult uterine hemorrhage diagnosed with bedside abdominal/pelvic ultrasound. Ultrasound was also used to insert a central venous catheter. After undergoing a hysterectomy to control hemorrhage and receiving activated factor VII, the patient recovered uneventfully. Hemodynamic management was optimized non-invasively using pulmonary and cardiac ultrasound, when the patient developed hemorrhagic shock followed by pulmonary edema. Volume replacement was guided by cardiac ultrasound findings, and we were able to detect incipient interstitial pulmonary edema and follow its course using pulmonary ultrasound.
  
  
  CONCLUSIONS
  Practitioners must be aware of the role of whole-body ultrasound in the diagnosis and treatment of complex, multi-organ conditions such as pre-eclampsia. Moreover, ultrasound helps in the management of global hemodynamics. The training of anesthesiologists in a variety of ultrasound techniques should be encouraged.
authors.affiliation: Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, chemin des Bourrely, 13015, Marseille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Zieleskiewicz
authors.forename: Candice
authors.initials: C
authors.lastname: Pierrou
authors.forename: Benoit
authors.initials: B
authors.lastname: Ragonnet
authors.forename: Maxime
authors.initials: M
authors.lastname: Tourret
authors.forename: Cécile
authors.initials: C
authors.lastname: Chau
authors.forename: Fabien
authors.initials: F
authors.lastname: Craighero
authors.forename: Claire
authors.initials: C
authors.lastname: Contargyris
authors.forename: Claude
authors.initials: C
authors.lastname: Martin
authors.forename: Marc
authors.initials: M
authors.lastname: Leone
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous / Q000295:instrumentation; D002585:Cesarean Section; D017548:Echocardiography, Transesophageal / Q000379:methods; D015942:Factor VIIa / Q000627:therapeutic use; D005260:Female; D017359:HELLP Syndrome / Q000000981:diagnostic imaging; D006406:Hematoma / Q000000981:diagnostic imaging; D006801:Humans; D007044:Hysterectomy; D010347:Patient Care Planning; D019095:Point-of-Care Systems; D006473:Postpartum Hemorrhage / Q000000981:diagnostic imaging*; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011654:Pulmonary Edema / Q000000981:diagnostic imaging / Q000628:therapy; D012771:Shock, Hemorrhagic / Q000628:therapy; D018617:Ultrasonography, Doppler, Pulsed; D018084:Ultrasonography, Interventional / Q000379:methods; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging; D051598:Whole Body Imaging / Q000379:methods*
chemical_list: D015942:Factor VIIa