PLACENTAL PERFUSION IN ONCOTIC TREATMENT OF SEVERE PREECLAMPSIA

Purpose: To evaluate placental perfusion (umbilical resistance index) in women with severe preeclampsia (SPE) on oncotic therapy.

Methods and Materials: Twelve women with SPE and Htc >0.38 received oncotic therapy with dextran 40 (n=2) and 6% HAES with antihypertensive agents (n=10). Eight women had IUGR with oligohydramnios in addition to SPE. Antihypertensive therapy included nifedipine in nine, urapidil in two, and methyldopa in one patient. Umbilical resistance index (URI) was measured every other day during therapy on a Kretz Voluson 700 ultrasound device

Results: A statistically significant decrease in URI and Htc (to 0.36±0.012) was recorded at gestational age of 34–36 weeks in 11/12 women on oncotic therapy. In the remaining case of refractory SPE with IUGR, antihypertensive therapy (methyldopa + nifedipine) failed to result in statistically significant URI and Htc reduction, and the baby was born with Apgar score 6/6 and umbilical pH 7.12. Other newborns did not have acidotic pH and were born with 5-min Apgar score >8. URI reduction was recorded in 8/9 women administered nifedipine along with oncotic therapy.

Conclusions: Oncotic therapy for preeclampsia along with antihypertensive agents has a clear physiopathologic basis. Oncotic therapy in SPE is aimed at improving and maintaining uteroplacental and maternal tissue perfusion, isovolemic hemodilution, and thromboprophylaxis.