Renal and cardiovascular repercussions in preeclampsia and their impact on fluid management: a literature review
Repercussões Renais e Cardiovasculares na Pré-Eclâmpsia e Seu Impacto no Gerenciamento de Fluidos: Uma Revisão da Literatura
Wallace Andrino da Silva, Aline Macedo Pinheiro, Paulo Henrique Lima, Luiz Marcelo S. Malbouisson
Abstract
Preeclampsia is a multifactorial condition associated with significant morbidity and mortality. Fluid therapy in these patients is challenging since volume expansion may precipitate pulmonary edema, and fluid restriction may worsen renal function. Furthermore, cardiac impairment may introduce an additional component to the hemodynamic management. This article reviews the repercussions of preeclampsia on renal and cardiovascular systems and the development of pulmonary edema, as well as to discuss fluid management, focusing on the mitigation of adverse outcomes and monitoring alternatives. The literature review was carried out using PubMed, Embase, and Google Scholar databases from May 2019 to March 2020. Papers addressing the subjects of interest were included regardless of the publication language. There is a current trend towards restricting the administration of fluids in women with non-complicated preeclampsia. However, patients with preeclampsia may experience hemorrhagic shock, requiring volume resuscitation. In this case, hemodynamic monitoring is recommended to guide fluid therapy while avoiding complications.
Keywords
Resumo
A pré-eclâmpsia é uma condição multifatorial associada a significativa morbimortalidade. A fluidoterapia nesses pacientes é um desafio, pois a expansão do volume pode precipitar edema pulmonar e a restrição de líquidos pode piorar a função renal. Além disso, o comprometimento cardíaco pode introduzir um componente adicional ao manejo hemodinâmico. Este artigo revisa as repercussões da pré-eclâmpsia nos sistemas renal e cardiovascular e no desenvolvimento de edema pulmonar, assim como discute o controle de fluidos, com ênfase na mitigação de desfechos adversos e alternativas de monitoramento. A revisão da literatura foi realizada nas bases de dados PubMed, Embase e Google Scholar de maio de 2019 a março de 2020. Os artigos que abordavam os assuntos de interesse foram incluídos independentemente do idioma de publicação. Existe uma tendência atual de restringir a administração de fluidos em mulheres com pré-eclâmpsia não complicada. No entanto, pacientes com pré-eclâmpsia podem apresentar choque hemorrágico, exigindo ressuscitação com volume. Nesse caso, a monitorização hemodinâmica é recomendada para orientar a fluidoterapia e evitar complicações.
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References
1 ACOG Practice Bulletin No. 202 Gestational hypertension and preeclampsia Obstet Gynecol, 133 (2019), pp. e1-e25
2 E. Abalos, C. Cuesta, A.L. Grosso, et al. Global and regional estimates of preeclampsia and eclampsia: a systematic review Eur J Obstet Gynecol Reprod Biol, 170 (2013), pp. 1-7
3 P. Vigil-De Gracia Maternal deaths due to eclampsia and HELLP syndrome Int J Gynaecol Obstet, 104 (2009), pp. 90-94
4 J.A. Hutcheon, S. Lisonkova, K.S. Joseph Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy Best Pract Res Clin Obstet Gynaecol, 25 (2011), pp. 391-403
5 JM Roberts, CW Redman Pre-eclampsia: more than pregnancy-induced hypertension Lancet, 341 (1993), pp. 1447-1451
6 J.W. Meekins, R. Pijnenborg, M. Hanssens, et al. A study of placental bed spiral arteries and trophoblast invasion in normal and severe pre-eclamptic pregnancies Br J Obstet Gynaecol, 101 (1994), pp. 669-674
7 J. Uzan, M. Carbonnel, O. Piconne, et al. Pre-eclampsia: pathophysiology, diagnosis, and management Vasc Health Risk Manag, 7 (2011), pp. 467-474
8 W.C. Mabie, T.E. Ratts, B.M. Sibai The central hemodynamics of severe preeclampsia Am J Obstet Gynecol, 161 (1989), pp. 1443-1448
9 A. Mehrabadi, S. Liu, S. Bartholomew, et al. Hypertensive disorders of pregnancy and the recent increase in obstetric acute renal failure in Canada: population based retrospective cohort study BMJ, 349 (2014), p. g4731
10 AT Dennis, CB Solnordal Acute pulmonary oedema in pregnant women Anaesthesia, 67 (2012), pp. 646-659
11 W.M. Callaghan, A.A. Creanga, E.V. Kuklina Severe maternal morbidity among delivery and postpartum hospitalizations in the United States Obstet Gynecol, 120 (2012), pp. 1029-1036
12 B. Thilaganathan Pre-eclampsia and the cardiovascular-placental axis Ultrasound Obstet Gynecol, 51 (2018), pp. 714-717
13 H. Perry, A. Khalil, B. Thilaganathan Preeclampsia and the cardiovascular system: an update Trends Cardiovasc Med, 28 (2018), pp. 505-513
14 J. Prakash, S.S. Niwas, A. Parekh, et al. Acute kidney injury in late pregnancy in developing countries Ren Fail, 32 (2010), pp. 309-313
15 F. Fakhouri, C. Vercel, V. Fremeaux-Bacchi Obstetric nephrology: AKI and thrombotic microangiopathies in pregnancy Clin J Am Soc Nephrol, 7 (2012), pp. 2100-2106
16 Y. Bentata, B. Housni, A. Mimouni, et al. Acute kidney injury related to pregnancy in developing countries: etiology and risk factors in an intensive care unit J Nephrol, 25 (2012), pp. 764-775
17 Y. Liu, X. Ma, J. Zheng, et al. Pregnancy outcomes in patients with acute kidney injury during pregnancy: a systematic review and meta-analysis BMC Pregnancy Childbirth, 17 (2017), p. 235
18 A. Gul, H. Aslan, A. Cebeci, et al. Maternal and fetal outcomes in HELLP syndrome complicated with acute renal failure Ren Fail, 26 (2004), pp. 557-562
19 C.M. Nzerue, K. Hewan-Lowe, C. Nwawka Acute renal failure in pregnancy: a review of clinical outcomes at an inner-city hospital from 1986-1996 J Natl Med Assoc, 90 (1998), pp. 486-490
20 E.V. Kuklina, C. Ayala, W.M. Callaghan Hypertensive disorders and severe obstetric morbidity in the United States Obstet Gynecol, 113 (2009), pp. 1299-1306
21 B.M. Sibai, M.K. Ramadan, I. Usta, et al. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) Am J Obstet Gynecol, 169 (1993), pp. 1000-1006
22 J. Szczepanski, A. Griffin, S. Novotny, et al. Acute kidney injury in pregnancies complicated with preeclampsia or HELLP syndrome Front Med (Lausanne), 7 (2020), p. 22
23 KL Cheung, RA Lafayette Renal physiology of pregnancy Adv Chronic Kidney Dis, 20 (2013), pp. 209-214
24 S. Rao, B. Jim Acute kidney injury in pregnancy: the changing landscape for the 21st century Kidney Int Rep, 3 (2018), pp. 247-257
25 R. Bellomo, C. Ronco, J.A. Kellum, et al. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group Crit Care, 8 (2004), pp. R204-12
26 R.L. Mehta, J.A. Kellum, S.V. Shah, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury Crit Care, 11 (2007), p. R31
27 J.A. Lopes, S. Jorge The RIFLE and AKIN classifications for acute kidney injury: a critical and comprehensive review Clin Kidney J, 6 (2013), pp. 8-14
28 A. Balofsky, M. Fedarau Renal failure in pregnancy Crit Care Clin, 32 (2016), pp. 73-83
29 J. Prakash, V.C. Ganiger Acute kidney injury in pregnancy-specific disorders Indian J Nephrol, 27 (2017), pp. 258-270
30 C. Ganesan, S.E. Maynard Acute kidney injury in pregnancy: the thrombotic microangiopathies J Nephrol, 24 (2011), pp. 554-563
31 American College of O., Gynecologists, Task Force on Hypertension in P. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy Obstet Gynecol, 122 (2013), pp. 1122-1131
32 L.A. Magee, P.J. Yong, V. Espinosa, et al. Expectant management of severe preeclampsia remote from term: a structured systematic review Hypertens Pregnancy, 28 (2009), pp. 312-347
33 N.K. Krane, M. Hamrahian Pregnancy: kidney diseases and hypertension Am J Kidney Dis, 49 (2007), pp. 336-345
34 I.P. Gaugler-Senden, A.G. Huijssoon, W. Visser, et al. Maternal and perinatal outcome of preeclampsia with an onset before 24-weeks’ gestation. Audit in a tertiary referral center Eur J Obstet Gynecol Reprod Biol, 128 (2006), pp. 216-221
35 W. Ye, H. Shu, Y. Yu, et al. Acute kidney injury in patients with HELLP syndrome Int Urol Nephrol, 51 (2019), pp. 1199-1206
36 BM Sibai, MK Ramadan Acute renal failure in pregnancies complicated by hemolysis, elevated liver enzymes, and low platelets Am J Obstet Gynecol, 168 (1993), pp. 1682-1687 discussion 7-90
37 B.E. Vikse, L.M. Irgens, T. Leivestad, et al. Preeclampsia and the risk of end-stage renal disease N Engl J Med, 359 (2008), pp. 800-809
38 H.S. Gammill, A. Jeyabalan Acute renal failure in pregnancy Crit Care Med, 33 (2005), pp. S372-84
39 B. Thilaganathan, E. Kalafat Cardiovascular system in preeclampsia and beyond Hypertension, 73 (2019), pp. 522-531
40 I. Behrens, S. Basit, M. Melbye, et al. Risk of post-pregnancy hypertension in women with a history of hypertensive disorders of pregnancy: nationwide cohort study BMJ, 358 (2017), p. j3078
41 E. Kalafat, B. Thilaganathan Cardiovascular origins of preeclampsia Curr Opin Obstet Gynecol, 29 (2017), pp. 383-389
42 K. Melchiorre, R. Sharma, B. Thilaganathan Cardiovascular implications in preeclampsia: an overview Circulation., 130 (2014), pp. 703-714
43 M Sanghavi, JD Rutherford Cardiovascular physiology of pregnancy Circulation, 130 (2014), pp. 1003-1008
44 N.F. Gant, R.J. Worley, R.B. Everett, et al. Control of vascular responsiveness during human pregnancy Kidney Int, 18 (1980), pp. 253-258
45 N.F. Gant, G.L. Daley, S. Chand, et al. A study of angiotensin II pressor response throughout primigravid pregnancy J Clin Invest, 52 (1973), pp. 2682-2689
46 F.L. Foo, A.A. Mahendru, G. Masini, et al. Association Between prepregnancy cardiovascular function and subsequent preeclampsia or fetal growth restriction Hypertension, 72 (2018), pp. 442-450
47 J.S. Castleman, R. Ganapathy, F. Taki, et al. Echocardiographic structure and function in hypertensive disorders of pregnancy: a systematic review Circ Cardiovasc Imaging, 9 (2016), Article e004888
48 G.P. Guy, H.Z. Ling, P. Garcia, et al. Maternal cardiac function at 35-37 weeks’ gestation: prediction of pre-eclampsia and gestational hypertension Ultrasound Obstet Gynecol, 49 (2017), pp. 61-66
49 L. Mosca, E.J. Benjamin, K. Berra, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women–2011 update: a guideline from the american heart association Circulation, 123 (2011), pp. 1243-1262
50 Y.S. Lin, C.H. Tang, C.Y. Yang, et al. Effect of pre-eclampsia-eclampsia on major cardiovascular events among peripartum women in Taiwan Am J Cardiol, 107 (2011), pp. 325-330
51 L. Brouwers, A.J. van der Meiden-van Roest, C. Savelkoul, et al. Recurrence of pre-eclampsia and the risk of future hypertension and cardiovascular disease: a systematic review and meta-analysis BJOG, 125 (2018), pp. 1642-1654
52 I.V. Alsnes, L.J. Vatten, A. Fraser, et al. Hypertension in pregnancy and offspring cardiovascular risk in young adulthood: prospective and sibling studies in the HUNT study (Nord-Trondelag Health Study) in Norway Hypertension, 69 (2017), pp. 591-598
53 Y.H. Li, N. Novikova Pulmonary artery flow catheters for directing management in pre-eclampsia Cochrane Database Syst Rev (2012), Article CD008882
54 Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy, National Institute for Health and Clinical Excellence: Guidance, London (2010)
55 M.M. Amorim, L. Katz, M. Valenca, et al. Severe maternal morbidity in an obstetric ICU in Recife, Northeast of Brasil Rev Assoc Med Bras (1992), 54 (2008), pp. 261-266
56 B.M. Sibai, B.C. Mabie, C.J. Harvey, et al. Pulmonary edema in severe preeclampsia-eclampsia: analysis of thirty-seven consecutive cases Am J Obstet Gynecol, 156 (1987), pp. 1174-1179
57 S.A. Lowe, M.A. Brown, G.A. Dekker, et al. Guidelines for the management of hypertensive disorders of pregnancy 2008 Aust N Z J Obstet Gynaecol, 49 (2009), pp. 242-246
58 A.C.B. Pordeus, L. Katz, M.C. Soares, et al. Acute pulmonary edema in an obstetric intensive care unit: a case series study Medicine (Baltimore), 97 (2018), Article e11508
59 ST Bauer, KL Cleary Cardiopulmonary complications of pre-eclampsia Semin Perinatol, 33 (2009), pp. 158-165
60 A.J. Vaught, L.C. Kovell, L.M. Szymanski, et al. Acute cardiac effects of severe pre-eclampsia J Am Coll Cardiol, 72 (2018), pp. 1-11
61 E.R. Norwitz, C.D. Hsu, J.T. Repke Acute complications of preeclampsia Clin Obstet Gynecol, 45 (2002), pp. 308-329
62 S. Gandhi, D. Sun, A.L. Park, et al. The pulmonary edema preeclampsia evaluation (PEPE) study J Obstet Gynaecol Can, 36 (2014), pp. 1065-1070
63 J.F. Brichant, G. Brichant, P.Y. Dewandre, et al. Circulatory and respiratory problems in preeclampsia Ann Fr Anesth Reanim, 29 (2010), pp. e91-5
64 JH Poole, DT Spreen Acute pulmonary edema in pregnancy J Perinat Neonatal Nurs, 19 (2005), pp. 316-331
65 C.E. Thornton, P. von Dadelszen, A. Makris, et al. Acute pulmonary oedema as a complication of hypertension during pregnancy Hypertens Pregnancy, 30 (2011), pp. 169-179
66 RG Wilkerson, AC Ogunbodede Hypertensive Disorders of Pregnancy Emerg Med Clin North Am, 37 (2019), pp. 301-316
67 KH Coppage, BM Sibai Treatment of hypertensive complications in pregnancy Curr Pharm Des, 11 (2005), pp. 749-757
68 European Society of G, Association for European Paediatric C, German Society for Gender M, et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC) Eur Heart J, 32 (2011), pp. 3147-3197
69 P. Dolley, A. Lebon, G. Beucher, et al. Acute pulmonary edema and pregnancy: a descriptive study of 15 cases and review of the literature J Gynecol Obstet Biol Reprod (Paris), 41 (2012), pp. 638-644
70 I.M. van Hagen, J. Cornette, M.R. Johnson, et al. Managing cardiac emergencies in pregnancy Heart, 103 (2017), pp. 159-173
71 MW Elliott Non-invasive ventilation: established and expanding roles Clin Med (Lond), 11 (2011), pp. 150-153
72 S. Perbet, J.M. Constantin, F. Bolandard, et al. Non-invasive ventilation for pulmonary edema associated with tocolytic agents during labour for a twin pregnancy Can J Anaesth, 55 (2008), pp. 769-773
73 J Anthony, LK Schoeman Fluid management in pre-eclampsia Obstet Med, 6 (2013), pp. 100-104
74 L.A. Magee, A. Pels, M. Helewa, et al. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary J Obstet Gynaecol Can, 36 (2014), pp. 416-441
75juence of fluid management on outcomes in preeclampsia: a systematic review and meta-analysis
Int J Obstet Anesth, 34 (2018), pp. 85-95
76 G. Hofmeyr, A. Cyna, P. Middleton Prophylactic intravenous preloading for regional analgesia in labour Cochrane Database Syst Rev (2004), Article CD000175
77 NICE Guideline [NG133]. Hypertension in pregnancy: diagnosis and management. https://www.nice.org.uk/guidance/ng133. Published: June 2019. Accessed March 12, 2020.
78 L. Duley, J. Williams, D.J. Henderson-Smart Plasma volume expansion for treatment of women with pre-eclampsia Cochrane Database Syst Rev (2000), Article CD001805
79 W. Ganzevoort, A. Rep, G.J. Bonsel, et al. A randomised controlled trial comparing two temporising management strategies, one with and one without plasma volume expansion, for severe and early onset pre-eclampsia BJOG, 112 (2005), pp. 1358-1368
80 B.W.J. Mol, C.T. Roberts, S. Thangaratinam, et al. Pre-eclampsia Lancet, 387 (2016), pp. 999-1011
81 JF von Schmidt auf Altenstadt, CW Hukkelhoven, J van Roosmalen, et al. Pre-eclampsia increases the risk of postpartum haemorrhage: a nationwide cohort study in the Netherlands PLoS One, 8 (2013), Article e81959
82 Y. Singh, S. Kochar, M. Biswas, et al. Hepatic rupture complicating HELLP syndrome in pregnancy Med J Armed Forces India, 65 (2009), pp. 89-90
83 C.V. Ananth, J.A. Lavery, A.M. Vintzileos, et al. Severe placental abruption: clinical definition and associations with maternal complications Am J Obstet Gynecol, 214 (2016), pp. 272.e1-272.e9
84 D. Ruth, B.B. Kennedy Acute volume resuscitation following obstetric hemorrhage J Perinat Neonatal Nurs, 25 (2011), pp. 253-260
85 A.M. El Ayadi, H.L. Nathan, P.T. Seed, et al. Vital sign prediction of adverse maternal outcomes in women with hypovolemic shock: the role of shock index PLoS One, 11 (2016), Article e0148729
86 C. Brun, L. Zieleskiewicz, J. Textoris, et al. Prediction of fluid responsiveness in severe preeclamptic patients with oliguria Intensive Care Med, 39 (2013), pp. 593-600
87 G. Lambert, J.F. Brichant, G. Hartstein, et al. Preeclampsia: an update Acta Anaesthesiol Belg, 65 (2014), pp. 137-149
88 A.T. Dennis Transthoracic echocardiography in women with preeclampsia Curr Opin Anaesthesiol, 28 (2015), pp. 254-260
89 L. Zieleskiewicz, C. Contargyris, C. Brun, et al. Lung ultrasound predicts interstitial syndrome and hemodynamic profile in parturients with severe preeclampsia Anesthesiology, 120 (2014), pp. 906-914
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