Ultrasonography for Fluid Assessment in Parturients With Preeclampsia Undergoing Cesarean Section

Performed at the L3-L4 or L4-L5 interspace using a 25-gauge spinal needle

Bupivacaine 12.5 mg (2.5 mL 0.5%) will be administered in the subarachnoid space

Fentanyl 15 μg will be administered in the subarachnoid space

Lower segment cesarean section using the Pfannenstiel incision

lung ultrasound scans will be performed while the patient is in the supine position with left lateral tilt by 30 degrees using a 2-5 MHz curved array transducer. The echo comet score (ECS) which corresponds to the amount of EVLW will be obtained by the 28-rib interspaces technique. An increased amount of (EVLW) is diagnosed by multiple B-lines or 'comet tails' which are defined as discrete laser-like vertical hyperechoic reverberation artifacts that arise from the pleural line and extend to the bottom of the screen without fading and move synchronously with lung sliding. The sum of the B-lines found on each of the 28 chest-wall areas yields the ECS.

The IVC largest and smallest diameters will be measured proximal to the opening of the M-mode using s2-4 MHz transducer placed longitudinally in the subcostal region.

Optic nerve sheath diameter measurement will be conducted in two axes of transverse and oblique sagittal using a 12-4MHz linear array transducer. Depth of the optic nerve will be localized and marked at 3 mm behind the retinal and optic nerve junction transverse diameter of optic nerve sheath will be calculated. The reported ONSD corresponds to the mean of the four values obtained for each patient transverse and sagittal plane for both eyes.

1000 ml ringer acetate will be administered over 2 hours.

Intravenous ephedrine 3, 5, and 10 mg will be administered when Systolic blood pressure decreases below 120, 110, and 90 mmHg, respectively.

Immediately after delivery, syntocinon 10 IU will be added to the running crystalloid solution.