Hemodynamic measurements with Swan‐Ganz catheter in women with severe proteinuric gestational hypertension (pre‐eclampsia)

Ten women with severe pre‐eclampsia, i.e. a blood pressure ≥ 150/110 mmHg or 140/90 mmHg and proteinuria > 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. This can be done by means of the Swan‐Ganz catheter in order to optimize treatment and clinical status before delivery in these severely ill patients.