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Point-of-care ultrasound in the critically ill pregnant or postpartum patient: what every intensivist should know

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Both authors contributed to the writing of this manuscript equally. Both authors read and approved the final manuscript.

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Correspondence to Pablo Blanco.

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ESM 1.

Table. Multi-organ point-of-care ultrasound (POCUS) in the pregnant or puerperium patient. The most important pathologies of this period that should be considered are summarized. To avoid incorrect interpretations, intensivists should know physiologic changes and their POCUS correlations well. (DOCX 46 kb)

ESM 2. Peripartum cardiomyopathy in the immediate puerperium of a young woman presenting with signs of congestive heart failure. Transthoracic echocardiogram (TTE) shows a dilated left ventricle (LV) with severely impaired systolic function; LV filling pressure is elevated as well. An intracardiac thrombus and a left-sided pleural effusion are also observed. (WMV 11654 kb)

ESM 3. Severe mitral valve stenosis in a patient presenting late in pregnancy with signs of congestive heart failure. TTE shows a normal LVEF, a dilated left atrium, a clearly reduced opening of the mitral valve (MV) leaflets, and a highly elevated mean MV gradient on continuous wave Doppler; pulmonary hypertension (not shown) was demonstrated as well. (WMV 2708 kb)

ESM 4.

Venous thromboembolic disease and pelvic septic thrombophlebitis in the puerperium (caesarean section) of a patient presenting with pelvic pain and dyspnea. a. Dilation of the right ventricle (D-shaped left ventricle). Impaired systolic function of the right ventricle (e.g., low tricuspid annular plane systolic excursion, not shown) was also evident. RV: right ventricle; LV: left ventricle; b. Lung ultrasound shows a subpleural consolidation in the right lung (arrows), a finding which may indicate a pulmonary infarction; c. Deep vein thrombosis, as demonstrated by a thrombus (T) in the right common femoral vein; d. Thrombus (T) extending to the infra-renal inferior vena cava (IVC) and thrombotic material alongside the IVC (arrows), corresponding to a thrombosed right ovarian vein (ovarian vein thrombophlebitis). aa: abdominal aorta; vb: vertebral body. (TIFF 8519 kb)

ESM 5. Hypovolemic shock in a patient with severe blood loss secondary to uterine atony. TTE shows depleted cardiac chambers, a tiny inferior vena cava and hyperdynamic ventricles. (WMV 5637 kb)

ESM 6. a.

Subfascial hematoma (arrows), observed as a heterogenous mass located in the prevesical space in a patient with fever, abdominal pain, and progressive diminishing of the hematocrit; b. Liver infarction as demonstrated by a hypoechoic liver pattern in the subcapsular region (arrows) in a patient with HELLP syndrome and right upper quadrant abdominal pain; c. Grossly enlarged kidney with increased parenchymal echogenicity, in a patient with pre-eclampsia and increased serum creatinine. (TIFF 4979 kb)

ESM 7.

Transcranial Doppler (TCD) in a patient with severe pre-eclampsia and signs of posterior reversible encephalopathy in computed tomography scan. a. Criteria of vasospasm as demonstrated by the grossly elevated velocities in the middle cerebral artery; b. Loss of cerebral autoregulation demonstrated by the transient hyperemic response test, in which there is absence of increase of velocities after releasing compression of the common carotid artery (CCA) at the base of the neck. (TIFF 6900 kb)

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Blanco, P., Abdo-Cuza, A. Point-of-care ultrasound in the critically ill pregnant or postpartum patient: what every intensivist should know. Intensive Care Med 45, 1123–1126 (2019).

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