The following is a summary of “Fluid Responsiveness and Management in Obstetrics using Point-of-Care Ultrasound,” published in the July 2024 issue of Obstetrics and Gynecology by MARTINS et al.

Effective fluid management in obstetric care is paramount, given the complex physiological dynamics of pregnancy, which challenge both clinical assessment and fluid balance optimization. This expert review explores the utility of point-of-care ultrasound (POCUS) in assessing and guiding fluid therapy responses among women who are pregnant.

Pregnancy induces significant physiological changes, including heightened cardiac output, increased glomerular filtration rate, reduced systemic vascular resistance, and altered plasma oncotic pressure. Conditions such as preeclampsia further complicate fluid management by reducing intravascular volume and increasing capillary permeability. Traditional methods of assessing fluid status, such as physical examination and invasive monitoring, often need to improve reliability or applicability in these contexts.

POCUS offers a noninvasive, rapid, and dependable approach to evaluating fluid responsiveness, crucial for effective fluid therapy management in women who are pregnant. This review discusses various POCUS modalities used to monitor dynamic fluid changes, focusing on assessments of the inferior vena cava (IVC), lung ultrasound (Lung US), and the left ventricular outflow tract (LVOT).

IVC ultrasound assesses diameter variability in patients who are spontaneously breathing, predicting fluid responsiveness even in late pregnancy. Lung ultrasound aids in the early detection of pulmonary edema, surpassing traditional radiography in accuracy and timeliness. LVOT velocity-time integral (VTI) measurements gauge stroke volume response to fluid challenges, offering a precise assessment of cardiac function, particularly valuable in critical care scenarios where prompt and accurate fluid management is crucial.

This expert review synthesizes current evidence and best practices, advocating for the integration of POCUS as a foundational tool in obstetric fluid management. It underscores the importance of ongoing research to refine techniques and validate their broader clinical utility. This emphasis on research aims to ensure the continued effectiveness of POCUS in obstetric care, thereby improving outcomes for patients who were pregnant and their infants.

Source: sciencedirect.com/science/article/abs/pii/S0002937824007300