BACKGROUND: Pregnancy-related cardiovascular physiologic changes increase the likelihood of pulmonary edema, with the risk of fluid extravasating into the pulmonary interstitium being potentially at a maximum during the early postpartum period. Data on the impact of labor and peripartum hemodynamic strain on lung ultrasound (LUS) are limited, and the prevalence of subclinical pulmonary interstitial syndrome in peripartum women is poorly described. The primary aim of this exploratory study was to estimate the prevalence of pulmonary interstitial syndrome in healthy term parturients undergoing vaginal (VD), elective (eCD), and unplanned intrapartum cesarean deliveries (uCD). Secondary aims were to estimate the prevalence of positive lung regions (≥3 B-lines on LUS per region) and to assess the associations between positive lung regions and possible contributing factors. METHODS: In this prospective observational cohort study, healthy women at term undergoing VD, eCD, or uCD were enrolled. Following international consensus recommendations, a LUS examination was performed within 4 hours after delivery applying an 8-region technique. Pulmonary interstitial syndrome was defined by the presence of 2 or more positive lung regions per hemithorax. Ultrasound studies were reviewed by 2 blinded reviewers and assessed for interobserver reliability. RESULTS: Seventy-five women were assessed (n = 25 per group). No pulmonary interstitial syndrome was found in the VD and eCD groups (each 0 of 25; 0%, 95% confidence interval [CI], 0-13.7). Pulmonary interstitial syndrome was found in 2 of 25 (8%, 95% CI, 1-26) women undergoing an uCD (P = .490 for VD versus uCD and P = .490 for eCD versus uCD). In 1 woman, this correlated clinically with the development of pulmonary edema. One or more positive lung regions were present in 5 of 25 (20%), 6 of 25 (24%), and 11 of 25 (44%) parturients following VD, eCD, and uCD, respectively (P = .136). Positive lung regions were predominantly found in lateral lung regions. The number of positive lung regions showed a weak correlation with patient age (r = 0.25, 95% CI, 0.05-0.47; P = .033). No significant association was found between LUS pattern and parity, duration of labor, labor augmentation, labor induction, estimated total intravenous fluid intake, or net intravenous fluid intake. CONCLUSIONS: Although many focal areas of increased extravascular lung water (20%–44% prevalence) can be identified on LUS, the overall prevalence of pulmonary interstitial syndrome was 2.7% (2 of 75; 95% CI, 0.3-9.3) among healthy term parturients soon after delivery. Focal areas of positive lung water regions were weakly correlated with maternal age.

中文翻译：

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健康产妇的床旁超声检查模式：阴道分娩、择期和计划外产时剖宫产后肺间质综合征的患病率

背景：妊娠相关的心血管生理变化增加了肺水肿的可能性，在产后早期液体外渗到肺间质的风险可能最大。关于分娩和围产期血流动力学应变对肺超声 (LUS) 影响的数据有限，围产期妇女亚临床肺间质综合征的患病率也鲜有描述。这项探索性研究的主要目的是评估接受阴道 (VD)、择期 (eCD) 和计划外剖宫产 (uCD) 的健康足月产妇肺间质综合征的患病率。次要目的是估计阳性肺区域的患病率（每个区域在 LUS 上≥3 B 线）并评估阳性肺区域与可能的促成因素之间的关联。方法：在这项前瞻性观察性队列研究中，纳入了接受 VD、eCD 或 uCD 的足月健康女性。根据国际共识建议，在分娩后 4 小时内使用 8 区技术进行了 LUS 检查。肺间质综合征定义为每个半胸有 2 个或更多阳性肺区域。超声研究由 2 位不知情的审查员审查，并评估观察者间的可靠性。结果：评估了 75 名女性（每组 n = 25）。在 VD 和 eCD 组中未发现肺间质综合征（25 组中各为 0；0%、95% 置信区间 [CI]，0-13.7）。在接受 uCD 的 25 名（8%，95% CI，1-26）名女性中有 2 名发现肺间质综合征（VD 与 uCD 的 P = .490，eCD 与 uCD 的 P = .490）。在 1 名女性中，这在临床上与肺水肿的发展相关。VD、eCD 和 uCD 后 25 名产妇中的 5 名 (20%)、25 名产妇中的 6 名 (24%) 和 25 名 (44%) 产妇中的 11 名分别存在一个或多个阳性肺区域 (P = .136)。阳性肺区域主要在侧肺区域中发现。阳性肺区域的数量与患者年龄呈弱相关（r = 0.25，95% CI，0.05-0.47；P = .033）。未发现 LUS 模式与产次、分娩持续时间、分娩增加、引产、估计总静脉液体摄入量或净静脉液体摄入量之间存在显着关联。结论：尽管在 LUS 上可以确定血管外肺水增加的许多焦点区域（20%–44% 患病率），但在健康足月产妇中，肺间质综合征的总体患病率为 2.7%（75 名中的 2 名；95% CI，0.3-9.3）交货后不久。阳性肺水区的焦点区域与母亲年龄弱相关。