Longitudinal evaluation of hemodynamic changes in eclampsia

Eight primigravid women with eclampsia underwent invasive hemodynamic monitoring shortly after admission and showed initial low right and left ventricular filling pressures, hyperdynamic left ventricular function, and elevated systemic vascular resistance. These findings persisted throughout 12 postpartum hours, with management that consisted of restriction of fluid, magnesium sulfate, and intermittent hydralazine for severe hypertension. Thereafter, those women without spontaneous diuresis had elevated pulmonary capillary wedge pressures despite hyperdynamic ventricular function. We hypothesize that this phenomenon was due to mobilization of extracellular extravascular fluid prior to diuresis. Comparison of these women with those with severe preeclampsia previously reported by others suggests that their hemodynamic status is significantly influenced by differences in fluid management.