Background - Maternal mortality from treatable causes concerning the critical care domain in
low- income countries remains strikingly high. Maternal mortality in Sierra Leone is the
highest in the world with 1,360 deaths per 100,000 born alive. The burden of
obstetric-related critical care morbidity is also extremely high. In high-income countries
less than 2% of intensive care unit admissions relate to obstetric illnesses, but these rise
to 10% in resource-limited settings. Pre-eclampsia/eclampsia are hypertensive disorders of
pregnancy, one of the 3 leading causes of maternal morbidity and mortality worldwide.
Respiratory distress and pulmonary oedema are known complications of preeclampsia-eclampsia
and their insurgence is a hallmark of severe disease. Pulmonary oedema is reported as a
complication in 2.9% of patients with preeclampsia-eclampsia. Pulmonary involvement is
associated with worse maternal and perinatal outcomes. Incidence is significantly higher in
low income countries, rising to 12% due to poorer prenatal care and access to hospital care,
and suboptimal diagnostic and management processes .
Aim - The primary aim is to describe the frequency of lung ultrasound consistent with
pulmonary oedema and the timing of resolution after delivery.
Secondary aims include the assessment of the frequency of acute respiratory failure, other
LUS findings beyond pulmonary edema, the assessment of oxygenation, the use of respiratory
organ support strategies, assessment of cardiac function, and quantification of major direct/
indirect obstetric complications and of perinatal complications.
Hypothesis -
A high proportion (>20%) of patients show LUS signs consistent with pulmonary edema
before delivery.
There is incomplete resolution of both clinical and ultrasound signs after in the 72
hours after delivery.
Setting - Princess Christian Maternity Hospital, Freetown, Sierra Leone Population - Female
subjects, hospitalized with severe preeclampsia or eclampsia Methods - Single centre,
prospective, cohort study of patients with severe pre-eclampsia and eclampsia. The expected
duration of study is 1 year. All patients with suspected severe pre-eclampsia or eclampsia
will undergo screening upon admission to HDU and the Eclamptic ward. Eligible patients will
undergo a systematic clinical and LUS examination, straight after admission (before
delivery). Clinical examination will focus on signs of respiratory, neurologic and cardiac
failure. Lung ultrasound will be performed using a Butterfly ultrasound probe (Butterfly,
USA). Lung ultrasound will be performed using the validated 12-region method. As heart
failure is a common finding in preeclamptic women, echocardiography performed with a cardiac
sector probe, will enable real-time assessment of maternal cardiac contractility and cardiac
output. The same clinical, LUS and echocardiographic assessment will be repeated between 24 h
to 72 h (after delivery). Whenever the pre-delivery timepoint is not feasible due to late
arrival, emergency scenario or postpartum onset, the after delivery examination only will be
performed.