Evaluating ventricular function with B-type natriuretic peptide in obstetric patients

OBJECTIVE: To determine if a rapid serum assay for B-type natriuretic peptide (BNP) provides information regarding ventricular function in obstetric patients with acute dyspnea. STUDY DESIGN: A review of 17 charts for 15 patients was undertaken. Seven patients had preeclampsia, 3 had preterm labor treated with aggressive tocolysis, and 5 had underlying cardiac and/or pulmonary disease. Each presented with signs and symptoms consistent with acute dyspnea. Serum BNP levels were obtained and other standard diagnostic procedures performed. Each patient was treated based on the findings of the standard diagnostic procedures. RESULTS: For the 7 patients with preeclampsia, elevated serum BNP levels correlated with acute ventricular overload that responded to volume management and diuresis. Two patients had marked elevation of serum BNP levels and were found to have significant left ventricular dysfunction that was not apparent by standard clinical evaluation. For preterm labor patients on tocolyis and patients with underlying cardiac or pulmonary disease, serum BNP levels were elevated for 5 of 6 patients with evidence of acute volume overload. CONCLUSION: Serum BNP levels provided useful information for the clinical evaluation and management of obstetric patients with acute dyspnea. In 2 patients, more serious cardiac dysfunction was detected with BNP than with clinical evaluation alone.