Abstract: Poster Presentations |

Use of Noninvasive Positive Airway Pressure During Wakefulness for the Treatment of Hypertension in Pregnancy FREE TO VIEW

Deborah A. Hutter, MD*; S. Edward Davis, III, MD; Manuel Alvarez, MD; Hormoz Ashtyani, MD
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Hackensack University Medical Center- UMDNJ, Fort Lee, NJ


Chest. 2004;126(4_MeetingAbstracts):901S. doi:10.1378/chest.126.4_MeetingAbstracts.901S-a
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PURPOSE:  To measure the effect of noninvasive positive airway pressure ventilation on maternal hypertension and fetal blood flow in women with pregnancy-associated hypertension during wakefulness.

METHODS:  Pregnant women hospitalized with new onset pregnancy-associated hypertension were screened for participation. Women were excluded with multiple gestations, fetal anomalies, sleep disorder or comorbid illness. Two women were enrolled. Both patients underwent a comprehensive sleep/wake history and performed an Epworth Sleepiness Scale. Both patients had blood pressure and umbilical artery dopplers performed with and without 15 cmH2O continuous positive airway pressure(CPAP).

RESULTS:  The first patient was a 35 year-old at 32 weeks gestation with an Epworth score of 7 and no snoring. She had a mean arterial blood pressure (MAP)of 97, fetal heart rate of 156 beats per minute (bpm), and a mid-cord umbilical artery systolic/diastolic (S/D) ratio of 1.88. On CPAP 15 cmH2O, her MAP decreased to 85 with a fetal heart rate of 174 bpm and a S/D ratio of 1.81. She continued to use an auto-titrating CPAP with an average pressure of 5-6 cmH2O. She underwent Cesarean section at 37 weeks to deliver a viable 2860 gram baby with an APGAR score of 8. The second patient was a 26 year-old at 35 weeks with an Epworth score of 8 and loud snoring. Her MAP was 121, with a fetal heart rate of 156 bpm and S/D ratio of 2.61. On CPAP 15 cmH2O, her MAP decreased to 110, with a fetal heart rate of 136 bpm and S/D ratio of 2.66. Her blood pressure was inadequately controlled and she also underwent Cesarean section. She delivered a viable 2565 gram baby with an APGAR of 7.

CONCLUSION:  In our patients, the use of CPAP resulted in improved daytime maternal-fetal hemodynamics. It would appear that even a small amount of positive pressure may result in an improvement in hemodynamics.

CLINICAL IMPLICATIONS:  We propose that the use of continuous positive airway pressure in pregnancy-associated hypertension may result in an improvement in maternal-fetal hemodynamics.

DISCLOSURE:  D.A. Hutter, None.

Wednesday, October 27, 2004

12:30 PM - 2:00 PM




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