D Stott1, O Nzelu1, K H Nicolaides2, N A Kametas1,2. 1. Antenatal Hypertension Clinic, Division of Women's Health, King's College Hospital, London, UK. 2. Harris Birthright Research Centre for Fetal Medicine, Division of Women's Health, King's College Hospital, London, UK.
Abstract
OBJECTIVES: To determine if, in a high-risk group of women in the first half of pregnancy, those who develop pre-eclampsia (PE) with fetal growth restriction (FGR) demonstrate distinct hemodynamics compared with those with PE in the absence of FGR (PE only). METHODS: Cardiac output (CO), peripheral vascular resistance (PVR) and mean arterial pressure (MAP) were measured at the first hospital visit at 9-24 weeks' gestation in 69 women who had chronic hypertension and 67 who had had a hypertensive disorder in a previous pregnancy. These women were divided into five groups according to pregnancy outcome. In total, 19 subsequently developed PE only, 22 developed PE with FGR, 17 developed pregnancy-induced hypertension, 39 had chronic hypertension without PE or FGR and 39 had had a hypertensive disorder in a previous pregnancy without PE, pregnancy-induced hypertension or FGR in the index pregnancy. The hemodynamic values in each of these groups were compared with those in a cohort of 300 low-risk women with normal pregnancy. RESULTS: In all the high-risk groups, PVR and MAP were higher than in women with a normal pregnancy, but CO was lower in the group of women with PE and FGR, whereas in the other high-risk groups, it was not significantly different from normal. CONCLUSIONS: In women who develop PE, there is evidence of high PVR and MAP from the first half of pregnancy, whilst PE and FGR are associated with failure in physiological expansion of CO.
OBJECTIVES: To determine if, in a high-risk group of women in the first half of pregnancy, those who develop pre-eclampsia (PE) with fetal growth restriction (FGR) demonstrate distinct hemodynamics compared with those with PE in the absence of FGR (PE only). METHODS: Cardiac output (CO), peripheral vascular resistance (PVR) and mean arterial pressure (MAP) were measured at the first hospital visit at 9-24 weeks' gestation in 69 women who had chronic hypertension and 67 who had had a hypertensive disorder in a previous pregnancy. These women were divided into five groups according to pregnancy outcome. In total, 19 subsequently developed PE only, 22 developed PE with FGR, 17 developed pregnancy-induced hypertension, 39 had chronic hypertension without PE or FGR and 39 had had a hypertensive disorder in a previous pregnancy without PE, pregnancy-induced hypertension or FGR in the index pregnancy. The hemodynamic values in each of these groups were compared with those in a cohort of 300 low-risk women with normal pregnancy. RESULTS: In all the high-risk groups, PVR and MAP were higher than in women with a normal pregnancy, but CO was lower in the group of women with PE and FGR, whereas in the other high-risk groups, it was not significantly different from normal. CONCLUSIONS: In women who develop PE, there is evidence of high PVR and MAP from the first half of pregnancy, whilst PE and FGR are associated with failure in physiological expansion of CO.
Authors: Eva Mulder; Chahinda Ghossein-Doha; Evine Appelman; Sander van Kuijk; Luc Smits; Rogier van der Zanden; Joris van Drongelen; Marc Spaanderman Journal: BMC Pregnancy Childbirth Date: 2020-12-12 Impact factor: 3.007
Authors: E G Mulder; S de Haas; Z Mohseni; N Schartmann; F Abo Hasson; F Alsadah; Smj van Kuijk; J van Drongelen; Mea Spaanderman; C Ghossein-Doha Journal: BJOG Date: 2021-04-06 Impact factor: 7.331