Abstract WP121: Cerebral Hemodynamics in the First Week Postpartum in Healthy Women and Women With Preeclampsia

Abstract

Objective: Standard adult normative data for transcranial Doppler (TCD)-based cerebral hemodynamic measures, such as mean and peak cerebral blood flow velocity (mCBFV, pCBFV), are used to identify pathological conditions such as postpartum angiopathy. However, little is known about cerebral hemodynamics during the early postpartum period, particularly in patients with preeclampsia (PEC). We characterized cerebral hemodynamics using TCD in the first week postpartum in patients with and without PEC. Methods: We prospectively recruited women with PEC and normotensive pregnant women delivering at an urban academic medical center. We measured CBFV in the bilateral middle cerebral arteries with TCD and calculated systolic mCBFV and pCBFV as well as pulsatility index (PI) and PI-derived noninvasive intracranial pressure (nICP). We compared systolic mCBFV and pCBFV between postpartum women with and without PEC, and historical data from non-pregnant young adult female controls. Results: Subjects were 51 women with PEC, 19 normotensive postpartum women, and 28 non-pregnant historical controls. In the PEC group, median mCBFV was 75.0 cm/s (IQR 65.2-99.1) and median pCBFV was 106.9 cm/s (IQR 92.7-130.8). In the normotensive postpartum group, median mCBFV was 77.1 cm/s (IQR 66.0-92.3) and median pCBFV was 107.9 cm/s (IQR 96.6-127.4). In the non-pregnant female control group, median mCBFV was 62.0 cm/s (IQR 48.5-67.9) and median pCBFV was 83.6 cm/s (IQR 69.3-95.2) (p<0.0001 for mean and peak 3-way comparisons; see Figure). PI and nICP were within normal range in both postpartum groups and did not differ significantly between groups. Conclusion: Postpartum women with and without PEC had mCBFV and pCBFV significantly higher than non-pregnant controls, and many fell outside the standard normal range for healthy adults, but PI and nICP were within normal range. Standard ranges of CBFV for healthy adults may not apply in the postpartum period.