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      Magnesium sulfate and ophthalmic artery Doppler velocimetry in patients with severe preeclampsia: a case series

      case-report

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          Abstract

          Background

          In the present study, we used Doppler velocimetry in the ophthalmic artery to evaluate the hemodynamic status of the intracranial vasculature. This is the first time in the literature that indices of ophthalmic artery Doppler sonography of women with preeclampsia were evaluated before and after the use of magnesium sulfate to prevent eclampsia.

          Case presentation

          Indices of ophthalmic artery Doppler sonography of six women with severe preeclampsia at 27 to 33 weeks of gestational age were evaluated before and after the use of magnesium sulfate (10 minutes, 30 minutes, and 60 minutes after the magnesium sulfate loading dosage. The patients’ ages were 26 years (patient 01), 29 years (patient 02), 20 years (patient 03), 21 years (patient 04), 20 years (patient 05), and 19 years (patient 06). The ethnic group of patients 01 and 04 was white and the ethnic group of patients 02, 03, 05 and 06 was mulatto.

          Conclusions

          The apparent increase in resistance index and pulsatility index values, although there is no statistical significance in this series of cases, and the decrease in peak ratio values after the administration of magnesium sulfate reflect an increase in the impedance to flow in the ophthalmic artery and consequently a reduction in cerebral perfusion after the use of magnesium sulfate. This may explain how magnesium sulfate protects women with severe preeclampsia against cerebral damage and prevents acute convulsions in these patients. We believe that this case series report may have a broader clinical impact across medicine because the mechanism of how magnesium sulfate can protect patients and prevent acute convulsions is controversial.

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          Most cited references20

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          Pre-eclampsia

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            Neurologic complications of pre-eclampsia.

            G G Zeeman (2009)
            Pre-eclampsia is mainly responsible for the world's large maternal mortality rates, mostly due to acute cerebral complications. This review provides insight into the pathogenesis of the neurologic complications of hypertensive disease in pregnancy. In addition, practical relevance for clinical care is highlighted. Pertaining to pregnancy, the blood pressure level at which cerebral autoregulation operates and possible deregulation occurs is unknown, but is likely to be variable. From clinical observation, eclampsia may occur despite a mild clinical picture and before the development of hypertension or proteinuria. Furthermore, failure of cerebrovascular autoregulatory mechanisms in response to either an acute and/or relatively large blood pressure increase may be more important than the absolute blood pressure value. It may be the acuity of the blood pressure rise in the setting of endothelial dysfunction that interrupts the delicate balance between capillary and cellular perfusion pressures that leads to the neurological complications of pre-eclampsia.
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              Ophthalmic artery Doppler as a measure of severe pre-eclampsia.

              To identify differences in orbital flow behavior in mild and severe pre-eclamptic women compared with healthy pregnant women, demonstrated by ophthalmic artery Doppler indexes.
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                Author and article information

                Contributors
                cristianeoliveira@perinatal.com.br
                +55-21-982093999 , rsa@cpdt.com.br
                kzamprogno@yahoo.com.br
                fabio.gutierrez@cpdt.com.br
                flavia.dovale@cpdt.com.br
                Journal
                J Med Case Rep
                J Med Case Rep
                Journal of Medical Case Reports
                BioMed Central (London )
                1752-1947
                20 November 2017
                20 November 2017
                2017
                : 11
                : 326
                Affiliations
                [1 ]ISNI 0000 0001 2184 6919, GRID grid.411173.1, Universidade Federal Fluminense - UFF, ; Niteroi, RJ Brazil
                [2 ]ISNI 0000 0001 0723 0931, GRID grid.418068.3, Instituto Fernandes Figueira/Fiocruz, ; Rio de Janeiro, RJ Brazil
                [3 ]Grupo Perinatal, Rio de Janeiro, RJ Brazil
                [4 ]Rua Mário Alves 69/1204 Icaraí, Niteroi, RJ Brazil
                Article
                1490
                10.1186/s13256-017-1490-1
                5694913
                29151361
                4f0e9ea6-09b2-4b2a-ba04-02ae6468dd59
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 13 July 2017
                : 12 October 2017
                Categories
                Case Report
                Custom metadata
                © The Author(s) 2017

                Medicine
                hypertension,ophthalmic artery,ultrasonography,doppler
                Medicine
                hypertension, ophthalmic artery, ultrasonography, doppler

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