ABSTRACT
Echocardiography is a powerful noninvasive tool that can be used in the evaluation and management of pregnant women with known or suspected cardiac disease. In this chapter we show that in addition, this modality can be used to evaluate the central hemodynamics of pregnant women with preeclampsia, oliguria, and/or cardiac failure. In this context, we demonstrate that with a little training and experience, the practicing obstetrician can master the rudiments of echocardiography to the extent that the state of filling of the vasculature, the cardiac output, the ejection fraction, and the peripheral vascular resistance can be assessed. This information can be invaluable in an obstetrical setting when it is important to know the state of filling of the vasculature or the status of cardiac function in order to make a decision regarding fluid therapy. Since most pregnant women have a healthy myocardium, it is often unnecessarily invasive to place a pulmonary artery catheter simply to determine whether the patient can tolerate a further fluid bolus infusion to treat oliguria. Under most circumstances a single evaluation of the state of vascular filling and of the cardiac function is sufficient to allow therapeutic adjustments and to eliminate the need for invasive hemodynamic monitoring. Thus, a knowledge of evaluation of the maternal heart and inferior vena cava is of significant value to the clinician. Since most recently
trained obstetricians, and many who trained prior to the general availability of ultrasound, have now acquired fetal imaging skills, the learning curve for maternal functional echocardiography is relatively steep.
