Incidence of pulmonary interstitial syndrome using point of care ultrasound in pregnant women with severe features of pre-eclampsia. A cohort study

BACKGROUND: Acute pulmonary oedema (APE) isthe leading cause of respiratory failure in severe pre-eclamptic patients. The incidence of APE is reported to be 2.9%.and it contributes to significant maternal and neonatal morbidity and mortality. (1) Recently many studies have found that point of care  lung ultrasound (LUS) identifies pulmonary oedema earlier than Chest x ray. (2) Point-of-care ultrasound (POCUS) is being used increasingly in preeclampsia for diagnostic purposes. (3) Using lung ultrasound, studies detected pulmonary interstitial syndrome (PIS) in 25% of women presenting with preeclampsia with severe features. In a study by Ortner et al, they found the incidence  PIS of 24%,diastolic dysfunction of 33%,systolic dysfunction of 10%  and raised left ventricular end-diastolic pressure (LVEDP) of 20%in pre-eclampsia patients with severe features. (4) Since there are no studies in our population, we wanted to observe the incidence of PIS and its association with diastolic dysfunction in preeclampsia with severe features. Also, there are no studies which associated these POCUS findings with adverse maternal outcomes.

 RATIONALE:  Circulating angiogenic factors, decreased colloid oncotic pressure, diastolic dysfunction, and endothelial cell dysfunction, have been reported as factors that predispose preeclamptic women to pulmonary edema, a dangerous complication that further increases the risk of morbidity and mortality. Due to this, pre-eclamptic women are more prone to develop pulmonary interstitial syndrome (PIS) (radiological diagnosis of increased accumulation of fluid in the lung), a preclinical manifestation of pulmonary edema. Although previous studies have  reported the incidence and association of PIS with diastolic dysfunction, we would like to observe the incidence of PIS and its association with diastolic dysfunction in our population because of ethnic differences in the incidence and complications of pre- eclampsia with severe features.

 NOVELTY: There is lack of literature regarding the incidence of pulmonary interstitial syndrome and its association with diastolic dysfunction in pre-eclamptic patients with severe features in our population.

EXPECTED OUTCOME:  With the above knowledge, it will help us to find out the incidence and association of PIS with diastolic dysfunction in our population. This will help us to know the incidence of PIS and identify subset of population who has more tendency to develop adverse maternal outcomes.