Thoracic Ultrasonography for Pulmonary Edema in Patients With Pre-Eclampsia
Condition: Pre-eclampsia
MeSH terms: Pulmonary Edema; Eclampsia; Pre-Eclampsia
Study type: Observational

Summary: 
      This project will study the use of ultrasound of the chest for the detection of fluid in the
      lungs in patients with pre-eclampsia vs pregnant patients without pre-eclampsia.
      Pre-eclampsia is a syndrome usually diagnosed in the second half of pregnancy in which
      patients develop elevated blood pressure and may develop protein in their urine, neurologic
      abnormalities, fluid in the lungs, and abnormal blood tests associated with the liver and
      kidney. Pulmonary edema (fluid in the lungs) in pre-eclampsia can lead to patient discomfort
      and significant morbidity and mortality. It can be detected using chest x-ray, although this
      type of imaging offers significant disadvantages, including radiation, which is of particular
      concern in pregnant patients. In addition, previous studies have demonstrated that chest
      x-ray is not very accurate in the detection of fluid in the lungs. Multiple previous studies
      have demonstrated the utility of chest ultrasonography in detecting fluid in the chest,
      although the vast majority of these studies involved patients with acute decompensated heart
      failure. Our goal is to evaluate bedside ultrasound of the chest in patients with
      pre-eclampsia in comparison to normal pregnant patients to determine whether these patients
      have abnormal fluid in the chest.

      The investigators will divide our patients into two groups. In the study group, the
      investigators will include patients with pre-eclampsia with or without shortness of breath,
      and in the control group, the investigators will include pregnant patients without
      pre-eclampsia. Informed consent will be obtained from all patients enrolled in the study.
      These patients will then undergo an ultrasound of the chest, performed by a member of the
      Emergency Medicine Ultrasound Division. The images will be transmitted wirelessly from the
      ultrasound machine to a secure web based cloud (Q-path) and will be subsequently reviewed by
      expert reviewers.
    

Detailed description: 
      This project will compare the use of ultrasound of the chest for the detection of fluid in
      the lungs in patients with pre-eclampsia vs pregnant patients without pre-eclampsia. Patients
      admitted to the obstetrical service will be recruited for study enrollment. We will divide
      our patients into two groups. In the study group, we will include patients with pre-eclampsia
      with or without shortness of breath, and in the control group, we will include otherwise
      healthy pregnant patients. We will exclude patients who are in labor or who are undergoing
      induction. Informed consent will be obtained from all patients enrolled in the study.

      Study subjects will then undergo an ultrasound of the chest, performed by a member of the
      Emergency Medicine Ultrasound Division, who have experience in performing lung ultrasounds.
      Both hemithoraces will be divided into 4 zones: anterior inferior, anterior superior, lateral
      inferior, and lateral superior. Each zone will be assessed for the presence of B-lines. For a
      zone to be considered "positive" for pulmonary edema, there should to be a minimum of 3
      B-lines. To diagnose a patient with pulmonary edema, at least two zones in both hemithoraces
      must be positive. The study investigator will document the presence of B-lines in each
      particular zone on the data collection sheet. Brief representative video clips will be
      recorded for each zone.

      After completing the sonographic examination, the images will be transmitted wirelessly from
      the ultrasound machine to a secure web based cloud (Q-path) and will be subsequently
      interpreted by expert reviewers who will be blinded to any clinical information about the
      patient. They will also document their findings on a separate data collection sheet.
    

Intervention name(s): Ultrasound
Intervention type(s): Device
Intervention description(s): Ultrasound of the chest for the detection of fluid in the lung
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Pregnant Females