Intraabdominal pressure in non-laboring preeclamptic vs normotensive patients undergoing cesarean section: A prospective observational study

Abstract

Introduction: It is hypothesized that increased intraabdominal pressure (IAP) may be a cause of preeclampsia. There is, however, a paucity of clinical data regarding IAP in preeclamptics. We evaluated and compared the IAP and its effects on organ functions, in normotensive and preeclamptic patients. Material and methods: Previously healthy non-laboring patients with a singleton pregnancy scheduled for elective cesarean section under subarachnoid block were enrolled (preeclamptic and normotensive; n = 29 each). IAP was measured using an indwelling Foley catheter, and compared in both cohorts at four predefined time points: just before subarachnoid block, immediately after the onset of sensory block to T6 dermatomal level, just after surgery, and 2 hours later. In addition, the presence of organ dysfunction for respiratory, cardiovascular, renal, hepatic, hematopoietic and central nervous systems were evaluated for association with IAP. Results: Although age, body mass index, gravidity, parity, serum bilirubin, serum creatinine, PaO2/FiO2 ratio and Glasgow coma score of the preeclamptic and normotensive patients were similar, the mean blood pressure was significantly higher (P < 0.001), the period of gestation less (P = 0.003) and the platelet count lower (P = 0.020) in the former. The IAP was significantly higher in the preeclamptic group at all four time points: respectively, 15.1 (1.0) vs 14.2 (0.9) mm Hg (P = 0.002); 14.9 (0.9) vs 14.1 (1.0) mm Hg (P = 0.002), 10.4 (1.0) vs 9.5 (1.3) mm Hg (P = 0.008) and 10.2 (0.8) vs 9.2 (1.2) mm Hg (P = 0.001). There was no correlation between the IAP and various organ dysfunctions. Conclusions: Preeclampsia is associated with a significantly higher IAP in patients undergoing a cesarean section. The clinical relevance of this finding needs further investigation.