OBJECTIVE: Pre-eclampsia is a serious complication of pregnancy with high morbidity and mortality and an incidence of 3-5% in all pregnancies. Early prediction is still insufficient in clinical practice. Although most pre-eclamptic patients have pathological uterine perfusion in the second trimester, perfusion disturbance has a positive predictive accuracy (PPA) only of approximately 30%. METHODS: Non-invasive continuous blood pressure recordings were taken simultaneously via a finger cuff for 30 min. Time series of systolic as well as diastolic beat-to-beat pressure values were extracted to analyse heart rate and blood pressure variability and baroreflex sensitivity in 102 second-trimester pregnancies, to assess predictability for pre-eclampsia (n = 16). All women underwent Doppler investigations of the uterine arteries. RESULTS: We identified a combination of three variability and baroreflex parameters to best predict pre-eclampsia several weeks before clinical manifestation. The discriminant function of these three parameters classified patients with later pre-eclampsia with a sensitivity of 87.5%, a specificity of 83.7%, and a PPA of 50.0%. Combined with Doppler investigations of uterine arteries, PPA increased to 71.4%. CONCLUSIONS: This technique of incorporating one-stop clinical assessment of uterine perfusion and variability parameters in the second trimester produces the most effective prediction of pre-eclampsia to date.
OBJECTIVE: Pre-eclampsia is a serious complication of pregnancy with high morbidity and mortality and an incidence of 3-5% in all pregnancies. Early prediction is still insufficient in clinical practice. Although most pre-eclamptic patients have pathological uterine perfusion in the second trimester, perfusion disturbance has a positive predictive accuracy (PPA) only of approximately 30%. METHODS: Non-invasive continuous blood pressure recordings were taken simultaneously via a finger cuff for 30 min. Time series of systolic as well as diastolic beat-to-beat pressure values were extracted to analyse heart rate and blood pressure variability and baroreflex sensitivity in 102 second-trimester pregnancies, to assess predictability for pre-eclampsia (n = 16). All women underwent Doppler investigations of the uterine arteries. RESULTS: We identified a combination of three variability and baroreflex parameters to best predict pre-eclampsia several weeks before clinical manifestation. The discriminant function of these three parameters classified patients with later pre-eclampsia with a sensitivity of 87.5%, a specificity of 83.7%, and a PPA of 50.0%. Combined with Doppler investigations of uterine arteries, PPA increased to 71.4%. CONCLUSIONS: This technique of incorporating one-stop clinical assessment of uterine perfusion and variability parameters in the second trimester produces the most effective prediction of pre-eclampsia to date.
Authors: Tammy Y Euliano; Kostas Michalopoulos; Savyasachi Singh; Anthony R Gregg; Mariem Del Rio; Terrie Vasilopoulos; Amber M Johnson; Allison Onkala; Shalom Darmanjian; Neil R Euliano; Monique Ho Journal: Anesth Analg Date: 2018-03 Impact factor: 5.108
Authors: Alison K Shea; Markad V Kamath; Alison Fleming; David L Streiner; Keith Redmond; Meir Steiner Journal: Clin Auton Res Date: 2008-06-30 Impact factor: 5.625
Authors: Virginia R Nuckols; Seth W Holwerda; Rachel E Luehrs; Lyndsey E DuBose; Amy K Stroud; Debra Brandt; Alexandria M Betz; Jess G Fiedorowicz; Sabrina M Scroggins; Donna A Santillan; Justin L Grobe; Curt D Sigmund; Mark K Santillan; Gary L Pierce Journal: Hypertension Date: 2020-09-21 Impact factor: 9.897