2025, Number 1
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Ginecol Obstet Mex 2025; 93 (1)
Measurement of the optic nerve sheath diameter by transorbital ultrasound in subjects with preeclampsia
Ruiz CJC, Martinz A, Reyes O
Language: Spanish
References: 26
Page: 13-23
PDF size: 440.93 Kb.
ABSTRACT
Objective: To determine the differences in optic nerve sheath diameter between
patients with severe pre-eclampsia and pregnant women with normal blood pressure,
and to establish a cut-off value that can be used to determine the diagnosis and risk
associated with this alteration.
Materiales and Methods: Prospective case-control study conducted from October
to December 2022 in the Obstetrics Department of the Maternity Unit of the Santo
Tomás Hospital, Panama.
Inclusion criteria: pregnant patients between 18 and 40 years
of age and between 34 and 40 weeks of gestation. The case group included patients
hospitalized for pre-eclampsia with severity criteria. Qualitative variables were reported
as frequencies and percentages, quantitative variables as means and standard deviations.
Mann-Whitney U and χ
2 tests were used for statistical analysis.
Results: We compared 53 patients with pre-eclampsia with severity criteria and 53
with normal blood pressure. In the former, the optic nerve sheath diameter was found to
be significantly larger compared to patients with normal blood pressure (pre-eclampsia:
5.42 ± 0.68 mm vs. normal blood pressure: 4.42 ± 0.34 mm; p ‹ 0.00001). ROC curve
analysis showed that the best cut-off value for optic nerve head diameter to diagnose
severe pre-eclampsia was 5.05 mm (sensitivity: 75.5%, specificity: 100%). No statistically
significant difference was observed in pregnant women with pre-eclampsia according
to the presence or absence of neurological symptoms (headache) with respect
to optic nerve sheath diameter (p = 0.32).
Conclusion: Pregnant women with pre-eclampsia with severe criteria have a larger
optic nerve sheath diameter compared to patients without blood pressure abnormalities.
REFERENCES
Li F, Wang T, Chen L, Zhang S, et al. Adverse pregnancyoutcomes among mothers with hypertensive disorders inpregnancy: a meta-analysis of cohort studies. PregnancyHypertens 2021; 24: 107-17. https://doi.org/10.1016/j.preghy.2021.03.001
Poon, LC, Nguyen-Hoang L, Smith GN, et al. Hypertensivedisorders of pregnancy and long-term cardiovascular health:FIGO Best Practice Advice. Int J Gynecol Obstet 2023; 160(Suppl. 1): 22- 34. https://doi.org/10.1002/ijgo.14540
Wang W, Xie X, Yuan T; et al. Epidemiological trends ofmaternal hypertensive disorders of pregnancy at theglobal, regional, and national levels: a population‐basedstudy. BMC Pregnancy Childbirth 2021; 21: 364. https://doi.org/10.1186/s12884-021-03809-2
Brouwers L, van der Meiden-van Roest AJ, Savelkoul C,Vogelvang TE, et al. Recurrence of pre-eclampsia and therisk of future hypertension and cardiovascular disease:a systematic review and meta-analysis. BJOG 2018; 125:1642-54. https://doi.org/10.1111/1471-0528.15394
Debette S, Markus HS. The clinical importance of whitematter hyperintensities on brain magnetic resonanceimaging: systematic review and meta-analysis. The BritishMedical Journal. 2010;341.
Long-term cerebral imaging after pre-eclampsia. BMJ 2012;119: 1117-22. https://doi.org/10.1136/bmj.c3666
McDermott M, Miller EC, Rundek T, Hurn PD, et al. Preeclampsia:association with posterior reversible encephalopathysyndrome and stroke. Stroke 2018; 49: 524-30.https://doi.org/10.1161/STROKEAHA.117.018416
Schwartz RB, Feske SK, Polak JF, DeGirolami U, et al.Preeclampsia-eclampsia: Clinical and neuroradiographiccorrelates and insights into the pathogenesis of hypertensiveencephalopathy. Radiology 2000; 217: 371-6. https://doi.org/10.1148/radiology.217.2.r00nv44371
Hypertension in pregnancy. Report of the American Collegeof Obstetricians and Gynecologists’ Task Force onHypertension in Pregnancy. Obstet Gynecol 2013; 122(5): 1122-31.
Betcher J, Becker TK, Stoyanoff P, et al. Military traineescan accurately measure optic nerve sheath diameter after abrief training session. Military Med Res 2018; 5: 42. https://doi.org/10.1186/s40779-018-0189-y
da Mota MF, de Amorim MM, Correia MDT, et al. Theoptic nerve sheath in hypertensive disorders of pregnancyand perinatal outcomes: a cohort study. BMC PregnancyChildbirth 2024; 24: 654. https://doi.org/10.1186/s12884-024-06858-5
Armstead WM. Cerebral Blood Flow Autoregulation andDysautoregulation. Anesthesiol Clin 2016; 34 (3): 465-77.https://doi.org/10.1016/j.anclin.2016.04.002
Chan SL, Chapman AC, Godfrey JA, Gokina N, et al. Effectof PPARγ inhibition during pregnancy on posterior cerebralartery function and structure. Frontiers Physiol 2010; 1:130. https://doi.org/ 10.3389/fphys.2010.00130
Cipolla MJ. The adaptation of the cerebral circulation topregnancy: mechanisms and consequences. JCBFM 2013;33 (4): 465-478. https://doi.org/10.1038/jcbfm.2012.210
Cipolla MJ. Cerebrovascular function during pregnancyand eclampsia. Hypertension 2007; 50: 14-24. https://doi.org/10.1161/HYPERTENSIONAHA.106.079442
Riazi K, Galic MA, Kuzmiski JB, Ho W, et al. Microglial activationand TNFalpha production mediate altered CNS excitabilityfollowing peripheral inflammation. Proc Natl AcadSci USA 2008; 105: 17151-56. https://doi.org/10.1073/pnas.0806682105
Donaldson JO. Eclampsia. Neurology of pregnancy. AdvNeurol 1994; 64: 25-33.
Bodanapally UK, Shanmuganathan K, Gunjan YP, SchwartzbauerG, et al. Quantification of iodine leakage on dualenergyCT as a marker of blood-brain barrier permeabilityin traumatic hemorrhagic contusions: prediction of surgicalintervention for intracranial pressure management. AJNR2019, 40 (12) 2059-2065. https://doi.org/10.3174/ajnr.A6316
Loureiro R, Leite CC, Kahhale S, Freire S, et al. Diffusionimaging may predict reversible brain lesions in eclampsiaand severe preeclampsia: Initial experience. Am J ObstetGynecol 2003; 189: 1350-5. https://doi.org/10.1067/S0002-9378(03)00651-3
Blaivas M, Theodoro D, Sierzenski P. Elevated intracranialpressure detected by bedside emergency ultrasonographyof the optic nerve sheath. Acad Emerg Med 2003;10: 376-81. https://doi.org/10.1111/j.1553-2712.2003.tb01352.x
Dubourg J, Javouhey E, Geeraerts T, Messerer M, et al.Ultrasonography of optic nerve sheath diameter for detectionof raised intracranial pressure: a systematic reviewand meta-analysis. Intensive Care Med 2011; 37: 1059-68.https://doi.org/10.1007/s00134-011-2224-2
Dubost C, Le Gouez A, Jouffroy V, Roger-Christoph S,et al. Optic nerve sheath diameter used as ultrasonographicassessment of the incidence of raised intracranialpressure in preeclampsia: a pilot study. Anesthesiology2012; 116:1066-71. https://doi.org/10.1097/ALN.0b013e318246ea1a
Simenc GB, Ambrozic J, Prokselj K, Tul N, et al. Ocularultrasonography for diagnosing increased intracranialpressure in patients with severe preeclampsia. Int J ObstetAnesth 2018; 36: 49-55. https://doi.org/10.1016/j.ijoa.2018.06.005
Singh SK, Bhatia K. Ultrasonographic Optic Nerve SheathDiameter as a Surrogate Measure of Raised IntracranialPressure in Severe Pregnancy-induced Hypertension Patients.Anesth Essays Res 2018; 12 (1): 42-46. https://doi.org/ 10.4103/aer.AER_218_17
Arzpeyma SF, Khorram PB, Asgharnia M, Mohtasham-Amiri Z. Investigating the relationship between ultrasoundmeasured optic nerve sheath diameter and preeclampsia.AIMS Medical Science 2019; 6 (3): 250-59. https://doi.org/10.3934/medsci.2019.3.250
Sterrett ME, Austin B, Barnes RM, Chang EY. Optic nervesheath diameter in severe preeclampsia with neurologicfeatures versus controls. BMC Pregnancy Childbirth 2022;22 (1): 224. https://doi.org/10.1186/s12884-022-04548-8