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

The monitoring of critically ill obstetric patients occasionally requires a level of consistent and reliable hemodynamic information which may be difficult to obtain by noninvasive means. Unusual acute demands for volume replacement undoubtedly support a continuing role for central vascular catheter placement. The decision to use a pulmonary artery catheter must weigh the perceived value of such information or therapy against the potential risk. A risk-benefit analysis for pulmonary artery catheter monitoring in obstetric patients should be completed as promptly as possible to aid the processes of clinical decision-making and informed consent. In each case, one must answer the question of whether sufficient data for competent medical management can be obtained through less invasive, safer methods. The continued development of sophisticated, noninvasive hemodynamic monitoring tools suggests that clinical alternatives will become more available for critical obstetric care.