Central and peripheral hemodynamics in severe preeclampsia.

Abstract

Doppler velocimetry, a new tool for measuring blood flow, vascular resistance, and central hemodynamics can be applied to monitor those patients at risk and provide therapeutic concepts for preeclampsia. This study was designed to use a Doppler velocimetry study to correlate the relationship between central hemodynamics, uteroplacental circulation, and the perinatal outcome in severe preeclampsia. Thirty-one patients with severe preeclampsia, not superimposed with any medical disorder and not on antihypertensive treatment prior to admission, were enrolled in this study. On admission, laboratory determination of the maternal blood chemistry and hematogram, together with a Doppler ultrasound study of the maternal hemodynamics, and umbilical and uterine arteries, were performed. Antihypertensive agents including hydralazine, atenolol, and labetolol were given according to the state of the maternal central hemodynamics. Data were collected on the general status of the patients, the results of the Doppler ultrasound study, and the perinatal outcome. Patients were divided into three groups based on the systemic vascular resistance. The left ventricular function and cardiac index declined with increase in vascular resistance. The high-resistance group had a significantly high incidence of infants small for gestational age. Poor fetal growth in the high-resistance group could be attributed to the summation of underperfusion due to decreased uteroplacental blood flow and was frequently associated with maternal hemoconcentration. Although global vasospasm has been considered to be the basic pathophysiology of preeclampsia, the central hemodynamics varies between, and even in the same, patients. Regional vasospasm in the uteroplacental circulation occurs earlier than in the systemic circulation as a whole. A high cardiac-output in low systemic-vascular-resistance might compensate in those pregnancies with high uterine artery resistance to maintain adequate uteroplacental perfusion.