Invasive hemodynamic monitoring in obstetrics. A critical review of its indications, benefits, complications, and alternatives.

(Chest 1992; 101:1429-33) T he pulmonary artery catheter was first described in 1970 l)y Swan, Ganz and associates. ‘ During the next decade, it rapidly evolved from a research device into a clinical tool. The pulmonary artery catheter has been successfully used for determination of cardiac output and other hemodynamic parameters to aid the clinical assessment of critically ill patients. In the United States, it has been estimated that 1 million pulmonary artery catheters are used each year; by contrast, only 6,()O() are used annually in the United Kingdonl . Many factors probably contril)ute to the dramatic increase in usage of these catheters. These include the physician’s anxiety to “know all and do everything:’ the fear of medicolegal liability in critical care, and the lack ofassurance that adequate monitoring is possible with less invasive means. The puln onary artery catheter has beeii used extensively in internal medicine, trauma care, cardiothoracic surgery, and anesthesiology These disciplines have contributed to a growing I)ody of literature detailing the risks and benefits of pulnioiiary artery catheter Im)nitoring.3 The safety and utility of this modality has been controversial.16 Critically ill obstetric 1)atients differ from those usually encountered in medical-surgical intensive care titiits; they are likely to I)e younger, to have fe ver major organ systenls involved, tohave fe verchronic illnesses, and to recover fully vith supportive care. Pulmonary artery catheter monitormg of critically ill obstetric 1)atients is a relatively recent approach, and reported experience remains limited.72’ This critical review of pulmonary artery catheter monitoring in obstetric care was undertaken s’ith the following goals: (1) to discuss its indications and techniques; (2) to identify methodologic risks and hazards; (3) to evaluate the current reported clinical experience; and (4) to lresent alternative approaches for hemodynamic management and assessment.