Internal Jugular Vein Collapsibility Index for Volume Status Assessment in Preeclampsia in Correlation With Normotensive Parturients

Internal Jugular Vein Collapsibility Index for Volume Status Assessment in Preeclampsia in Correlation With Normotensive Parturients: a Prospective Observational Cohort Study

This study aims to assess and analyze volume status in preeclamptic patients and compare these parameters with those of normotensive pregnant ones based on the change in internal jugular vein ultrasound-based indices.

Study Overview

• Status: Recruiting
• Conditions: Pre-Eclampsia; Preeclampsia

Detailed Description

Preeclampsia is a hypertensive disorder of pregnancy that remains a leading cause of maternal and perinatal morbidity and mortality worldwide, particularly in low- and middle-income countries. It is characterized by endothelial dysfunction, increased vascular resistance, and fluid imbalance, all of which complicate perioperative management during cesarean delivery. Accurate assessment of intravascular volume status in these patients is critical for guiding fluid therapy, preventing hypovolemia that worsens uteroplacental perfusion, and avoiding fluid overload, which increases the risk of pulmonary edema - a major cause of maternal mortality in severe preeclampsia.

Traditionally, invasive methods such as central venous pressure (CVP) monitoring and pulmonary artery catheterization have been used to estimate intravascular volume and preload. However, these techniques are associated with significant risks, including infection, thrombosis, and procedural complications, making them unsuitable for routine use in obstetric patients. Non-invasive approaches, such as echocardiography and inferior vena cava (IVC) ultrasound, have been explored but have important limitations in preeclamptic parturients due to altered venous compliance, increased intra-abdominal pressure from gravid uterus, and technical challenges in obtaining consistent IVC windows.

Ultrasound assessment of the internal jugular vein (IJV) has emerged as a simple, rapid, and non-invasive and reproducible bedside technique for evaluating intravascular volume status. The IJV reflects central venous dynamics and can provide real-time information on venous collapsibility without the limitations posed by abdominal compression or operator dependency observed with IVC evaluation.

Importantly, preliminary data from previous study demonstrated that preoperative internal Jugular Vein collapsibility index strongly correlated with fluid status of the pregnant females undergoing cesarean section under spinal anesthesia.

Despite its potential, limited data exist regarding the use of IJV-based indices in preeclamptic parturients, the investigators hypothesize that IJV collapsibility index is a reliable marker of volume status and predictor of post-spinal hypotension in pre-eclamptic parturients , where vascular tone and compliance are significantly altered. This study aims to bridge this gap by assessing the internal jugular vein collapsibility index in pre-eclamptic parturients and comparing it with normotensive pregnant women to determine its clinical utility for optimizing perioperative fluid management.

The investigators hypothesize that this study helps to assess intravascular volume of preeclamptic Parturients to avoid hypovolemia or fluid overload which carry serious risk in this type of patients, both of which carry serious risks in this group of patients.

• Study Type: Observational
• Enrollment (Estimated): 80

Contacts and Locations

• Study Contact: Name: Abdelghany AA Mohamed, MBBCH; Phone Number: +201123676274; Email: Aldomiaty97@gmail.com

Study Locations

• Egypt
  • El-Gharbia Govenorate
    • Tanta, El-Gharbia Govenorate, Egypt, 31527
      • Recruiting
      • Tanta University Hospital
      • Contact: Hospital
      • Contact: U

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

Patients admitted at obstetric theater in Tanta University Hospital

Description

Inclusion Criteria:

1. Singleton parturients from 18 to 40 years old.
2. Either normotensive or preeclamptic parturients scheduled for elective cesarean section under neuro-axial block matched for gestational age 28-40 weeks will be included:
3. Normotensive group: uncomplicated normotensive pregnancy with systolic blood pressure below 140 mmHg and diastolic blood pressure below 90mmHg without proteinuria.

4. Preeclamptic Group: new onset preeclamptic pregnant female with gestational hypertension after 20 weeks of pregnancy diagnosed based on ISSHP Guidelines: systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg, accompanied by one or more of the following:

   • Proteinuria (≥300 mg in a 24-hour urine sample)
   • Alb/Cr ratio ≥30 mg/mmol,
   • Organ dysfunction (renal insufficiency (creatinine level>1.1mg%), liver involvement (liver enzyme levels ≥3 times normal), neurological complications (Headache and blurring of vision) and hematological involvement (thrombocytopenia<100.000)).

Exclusion Criteria:

1. Parturients with pre-existing cardiac & vascular disease affecting blood volume and vascular compliance: (Valvular or congenital heart disease, arrhythmia, previous history of venous thromboembolism, chronic kidney disease, gestational diabetes).
2. multiple gestations
3. known thyroid disorders or chronic hypertension
4. patients with BMI >40 and patients requiring emergency delivery.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Preeclamptic Group; Parturients diagnosed with preeclampsia diagnosed according to established diagnostic criteria of ISSHP: Pregnant female in the third trimester (after 20 weeks of pregnancy).
Control Group; Normotensive Parturients matched for gestational age at the time of Ultrasound.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Measuring internal jugular vein (IJV) collapsibility index	Measuring internal jugular vein (IJV) collapsibility index at end expiratory phase just before the induction of anesthesia and its correlation with normotensive parturients to determine the cut off value of fluid status in preeclamptic patient	Intra-operative

Secondary Outcome Measures

Outcome Measure	Time Frame
Association between internal jugular vein ultrasound-based indices and severity of Preeclampsia.	Intra-operative
Value of internal Jugular vein collapsibility index in predicting post spinal hypotension	Intra-operative

Collaborators and Investigators

• Sponsor: Tanta University

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2025
• Primary Completion (Estimated): September 1, 2026
• Study Completion (Estimated): September 1, 2026

Study Registration Dates

• First Submitted: August 21, 2026
• First Submitted That Met QC Criteria: August 21, 2026
• First Posted (Actual): August 25, 2026

Study Record Updates

• Last Update Posted (Actual): September 10, 2026
• Last Update Submitted That Met QC Criteria: September 5, 2026
• Last Verified: September 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Pregnancy Complications; Hypertension, Pregnancy-Induced; Pre-Eclampsia
• Other Study ID Numbers: 36264MS101010/10/25

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The data will be available upon a reasonable request from the corresponding author after the end of study for one year
• IPD Sharing Access Criteria: The data will be available upon a reasonable request from the corresponding author

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No