POCUS and pre-eclampsia: bedside echocardiography to guide resuscitation in cardiogenic shock with pre-eclampsia with severe features – a case report from a low and middle income country

Abstract

Pre-eclampsia is the second leading cause of maternal mortality worldwide, with over 99% of deaths occurring in low and middle income countries (LMICs). In South Africa, pre-eclampsia and obstetric haemorrhage are among the three primary causes of maternal mortality. These conditions pose significant challenges for even the most experienced healthcare providers with regular exposure to obstetric patients. Pre-eclampsia with severe features, in its most extreme form, can present with diastolic and systolic dysfunction and cardiogenic shock. This, in combination with a hypocoagulable state and hypovolemic shock from postpartum haemorrhage (PPH), can present a resuscitation conundrum for the anaesthetist. Point-of-care-ultrasonography (POCUS) is a useful tool to guide management of these complicated obstetric resuscitations.