Cardiac abnormalities in pulmonary oedema associated with hypertensive crises in pregnancy

Objective To describe the cardiac abnormalities by two-dimensional and Doppler echocardiography (echo-Doppler) in hypertensive crises in pregnancy (HCP) complicated by pulmonary oedema and identify pathogenic factors. Design A prospective observational study. Setting King Edward VIII Hospital, Durban, South Africa. Participants Sixteen patients with HCP complicated by pulmonary oedema over a six-month period. Two control groups, 55 patients with HCP alone and 16 with normotensive pregnancies, were also studied. Results Echocardiography diagnosed impaired left ventricular systolic function in 4 of 16 (25%) patients with HCP and pulmonary oedema. In the remaining 12 patients with preserved systolic function, left ventricular diastolic filing abnormalities were demonstrated in a significant proportion compared to control hypertensive and normotensive groups. Fifteen of 16 (94%) study patients presented with pulmonary oedema antepartum; in seven of these patients, the use of dexamethasone to enhance fetal lung maturity appeared to be a contributing factor in precipitating pulmonary oedema. Conclusion This study demonstrates the value of echo-Doppler to diagnose structural and functional cardiac abnormalities in HCP complicated by pulmonary oedema. The potential role of left ventricular diastolic filling abnormalities in the pathogenesis of pulmonary oedema complicating HCP is discussed.