Pulmonary artery catheters for directing management in condition associated with high blood pressure during pregnancy

Pre-eclampsia (a condition associated with high blood pressure during pregnancy) or toxaemia affects a significant number of pregnancies and is a major cause of serious illness and even death of mothers and babies during pregnancy and shortly after. Pre-eclampsia can cause decreased blood flow to the kidneys resulting in kidney failure and fluid accumulation in the lungs and other organs. Managing fluid shifts is, thus, crucial to preventing and managing such complications. The pulmonary artery catheter is one method of monitoring fluid status. The pulmonary artery catheter is a special device placed inside of the pulmonary artery for  measurement of pressures in the different parts of heart, which helps to monitor the fluid balance in the body. Although it seem to be the most reliable method for monitoring of fluid shifts, the placement of pulmonary artery catheters may be associated with the highest risk of complications. No randomised trials involving pulmonary artery catheterisation were found and, thus, there is no robust data to support or disregard the use of this intervention. The complexity of this procedure and the skills needed to perform it may have affected the lack of randomised trials. Nevertheless, fluid management is still an important issue in managing and preventing kidney failure and accumulation of fluid in the lungs and other organs in the context of pre-eclampsia and pulmonary artery catheterisation is a potential technique for this. We think that further research, especially randomised trials, is needed.

Authors' conclusions: 

There is currently no evidence from randomised controlled trials supporting the use of the pulmonary artery catheters. Fluid management in pre-eclampsia, especially in the context of preventing or managing renal failure and pulmonary oedema, remains an important issue. Randomised trials dealing with this intervention are needed, however, we do recognise the difficulty in performing randomised trials due to the invasive nature of the procedure and skills involved in inserting a pulmonary flow catheter.

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Background: 

Gestational hypertension and pre-eclampsia can cause fluid shifts. Pulmonary oedema and renal failure can result from these shifts. Fluid management is crucial in managing pre-eclampsia, especially in the context of pulmonary oedema and renal failure. Pulmonary artery catheterisation may be a method of effectively monitoring fluid status and thus aid in the management of renal failure and pulmonary oedema in the context of pre-eclampsia.

Objectives: 

To assess the safety and efficacy of pulmonary flow catheters in women with severe pre-eclampsia in preventing and managing of renal failure and pulmonary oedema or both.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2012).

Selection criteria: 

Randomised trials evaluating the use of the pulmonary artery catheterisation in the management of pre-eclamptic and eclamptic antepartum, intrapartum and postpartum women.

Data collection and analysis: 

We did not identify any randomised controlled studies.

Main results: 

There are no included studies.

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