• D K Desai, J Moodley, D P Naidoo, and I Bhorat.
• MRC/UN Pregnancy Hypertension Research Unit, Faculty of Medicine, University of Natal, Durban, South Africa.
• Br J Obstet Gynaecol. 1996 Jun 1; 103 (6): 523-8.

ObjectiveTo describe the cardiac abnormalities by two-dimensional and Doppler echocardiography (echo-Doppler) in hypertensive crises in pregnancy (HCP) complicated by pulmonary oedema and identify pathogenic factors.DesignA prospective observational study.SettingKing Edward VIII Hospital, Durban, South Africa.ParticipantsSixteen patients with HCP complicated by pulmonary oedema over a six-month period. Two control groups, 55 patients with HCP alone and 16 with normotensive pregnancies, were also studied.ResultsEchocardiography diagnosed impaired left ventricular systolic function in 4 of 16 (25%) patients with HCP and pulmonary oedema. In the remaining 12 patients with preserved systolic function, left ventricular diastolic filling abnormalities were demonstrated in a significant proportion compared to control hypertensive and normotensive groups. Fifteen of 16 (94%) study patients presented with pulmonary oedema antepartum; in seven of these patients, the use of dexamethasone to enhance fetal lung maturity appeared to be a contributing factor in precipitating pulmonary oedema.ConclusionThis study demonstrates the value of echo-Doppler to diagnose structural and functional cardiac abnormalities in HCP complicated by pulmonary oedema. The potential role of left ventricular diastolic filling abnormalities in the pathogenesis of pulmonary oedema complicating HCP is discussed.

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